Neglect and abuse in a nursing home? According to a survey, this usually happens in secret, but takes place regularly – as nurses themselves admitted in the study. © Holger Hollemann/dpa
According to surveys, violence against residents of nursing homes is part of everyday life in many homes. But it is often a taboo among employees, and in many places there is a lack of concepts. The problem is likely to become bigger, as nurses and industry insiders report.
Munich/Augsburg – When nursing teacher Manuela Maria Müller wants to explain to her trainees what disturbing experiences one can have in a nursing home, she tells a personal story: At the beginning of her professional life, she works on a nursing ward in Augsburg. She has her first weekend shift with two colleagues, waking up the residents at 6 a.m. so that everyone is on time for breakfast. Some want to sleep longer, Müller is considerate. "The other two immediately blasphemed: What does she need so long?" recalls the 59-year-old. In the next room, she carefully pulls the blanket away from a resident, it should go faster. The old lady hits the young nurse's hands – Müller claps back in emotion.
A moment in which an abyss opens up: What is she still capable of when pressure, excessive demands and frustration push her beyond her limits? "That was 40 years ago, but the scene still haunts me because I was so horrified at myself," says Müller, who works in the Augsburg-Munich area. The consequence: Müller resigned, under such pressure she did not want to care.
Many have had similar experiences. For this text, nurses have provided insights into an industry in which various forms of violence are not the exception, but everyday life. They report neglect and residents being left in their diapers for hours. Of poor medical care and open lying ulcers that force medical treatments. They tell of colleagues who insult, ignore, humiliate.
Care expert Claus Fussek: "Violence in care is still a huge taboo"
Social worker and care expert Claus Fussek has been observing the industry for more than 40 years and is considered Germany's best-known care critic. "Violence in care is unfortunately still a huge taboo. In public, it is appropriate that the nurses are the victims – and not the perpetrators," he says. "Because we have declared this group to be heroines and heroes, we obviously no longer dare to look closely and name the actual problems."
In a 2017 study by the Foundation Center for Quality in Care (ZQP), 250 nursing service managers and quality officers were surveyed about violence in care. Almost half of them stated that conflicts, aggression and violence in care pose very special challenges for nursing homes. For a survey conducted by the German Police University in Münster in 2010, 72 percent of nursing staff from nursing homes stated that they had shown at least one behavior in the past twelve months that was considered neglect or abuse. Psychological abuse and nursing neglect were mentioned most frequently. In most cases, the respondents stated that this was done in secret and did not penetrate the broad circle of colleagues or superiors.
When the homes sealed themselves off during the pandemic, the already high number of unreported cases of violence is likely to have climbed upwards. Susanne F., a nursing student, is in her mid-20s and is currently completing her three-year generalist training. She doesn't want to read her real name in the newspaper because she fears it will have a negative impact on her career. She and her classmates have already made several stops in nursing homes – and have seen a lot, she reports. Sometimes residents are shouted at that they should not ring the bell so often. Sometimes a suppository is administered without warning in the intimate area. Sometimes a resident has bleeding gums because her teeth have been brushed so ruthlessly. Anyone who complains, says the nursing student, is threatened that the ambulance will pick him up right away.
The pressure in the industry has brought Torsten S. close to tablet addiction
Measures involving deprivation of liberty are also a major problem: "When residents wander around in the corridor at night, the tea trolley is deposited in front of the door to lock them in the room," says the nursing student. Do the trainees report such acts of violence to the management? "We are already in a conflict, after all we are the students and that is not welcome. I don't think anyone who has been working like this for 25 years will really change."
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Torsten S., born in 1965 and from near Augsburg, has been working in the industry for several decades and has also held management positions. The pressure brought him close to pill addiction, he says. The revision leaves its mark, not only on him. "When I come to the handover in the morning and all my colleagues are sitting in a circle, I can't say who was on night duty and who is now on duty. They all look the same," says S.
When it comes to violence, he doesn't have to look far for examples he observes: residents who have colleagues hold their noses in order to administer medication. Bruises on the residents, who obviously come from the night shift. Residents who ring too often at night and whose bells are taken away – which is fatal in an emergency. "I think that many people work in nursing who don't really belong there, who simply lack empathy," says S. "But you just let these colleagues run on." Because if the quota of employees is not met, there will be an occupancy freeze and no new residents will be admitted. "Of course, the management wants to prevent that. Many are simply no longer able to regulate themselves in stressful situations. And then terrible things happen."
One problem: people who are also unsuitable for the job remain - for lack of replacements
Nursing teacher Manuela Maria Müller, who once slipped his hand in the affect, sees the core of the violence problem, among other things, in the selection of trainees. Despite the lack of staff, the nursing students would have to be selected much more carefully. Who is really suitable and who is not, does not always have to do with school education. "It is of no use if trainees or well-trained nurses are brought in from abroad, they do not speak the language or do not speak it properly," says Müller. In addition, there are always German students who end up in nursing because they know no alternatives. Unstable personalities coupled with excessive demands lead to an explosive mixture: "In the homes, the trainees also encounter bad, burned-out role models who simply dispatch the elderly."
In addition, even students and nurses who are actually unsuitable would not be dismissed during the probationary period, but would remain in their jobs. "Those responsible often turn a blind eye." Trainees said, says Müller, that some things are swept under the table. And there are rarely contact persons who take care of the problem responsibly.
It is precisely here, when it comes to the question of responsibility, that the experts at the Center for Quality in Care also see a starting point for curbing violence in homes. Simon Eggert, Head of Research at the ZQP, considers the prevention of violence to be an ongoing task. "There are always risks of violence and neglect in nursing homes. Therefore, a culture of protection against violence should be established in institutions," says Eggert. In practice, however, the topic has so far only arrived to a limited extent. This is shown by a nationwide survey by the ZQP: In about half of the houses, there were no staff specially trained to deal with conflicts, aggression and violence. In about one-fifth of the facilities, the topic was not taken up in quality management. Against this background, Eggert also points out that a violence protection concept including a prevention officer on site is very important, but unfortunately not common.
Care expert Claus Fussek says it needs "relief, relief, relief", because many modest wishes of home residents can already be fulfilled with empathy and with enough time. "In exemplary nursing homes, which fortunately also exist, a fear-free working atmosphere is possible and there is an early warning system where problems and complaints are dealt with openly and honestly with relatives." Dignified care, Fussek emphasizes, we as a society should be willing to pay for something. This is because Article 1 of the Basic Law, the dignity of the human being, should not have an upper age limit.