The Sexual Abuse of Vulnerable Adults in Institutions

In 2000, Adult Protective Services (APS). typically the state agency of first contact in cases of abuse, neglect, or exploitation, received 473,095 domestic (in the community) and institutional (nursing homes, assisted living, group homes) reports concerning vulnerable adults. Included in that number were 4,150 reports of sexual abuse, a number highly under-reported due to differing reporting categories and its taboo nature. Sexual abuse runs the gamut from kissing and fondling to forcible rape, and, validated by earlier studies, results in a diminished quality of life and, often, premature death. Because sexual abuse poses a significant public health and public safety problem requiring government intervention, this study is grounded in democratic governance theory, which emphasizes responsivity, representativeness. and responsibility through government intervention. The specific aims are: (1.) to investigate patterns of the sexual abuse of vulnerable older and younger adults living in long-term care institutions; (2.) to test a web-based system for obtaining sensitive and confidentiai information on the sexual abuse of vulnerable adults; and (3.) to refine an emergent theory of the mistreatment of vulnerable adults derived from democratic governance theory. This multi-state study focused on four states (New Hampshire, Oregon, Tennessee, and Texas) will utilize survey data provided by APS staff regarding all reports, reports investigated, and reports that were substantiated. Data collection will be undertaken using a web-based protocol. To check for reliability of survey data, the Pis and APS supervisors will conduct a clustered, randomized review of 20% of APS files. A randomized sample of 15% of APS staff will complete in-depth telephone interviews regarding reports that were investigated only and reports substantiated. For nursing home residents only, data from resident's Minimum Data Set (MDS) will be collected six months prior to the report and six months after to provide a before and after picture of the resident who was sexually abused. To make comparisons about the types of facilities in which sexual abuse is occurring, the research team will use Nursing Home Compare, a Medicare website that provides public and facility specific information on all nursing homes receiving Medicare or Medicaid funds. We will analyze the data using descriptive statistics, Chi Squares, and logistic regression. This is the first systematic multi-state, theoretically grounded study to address the sexual abuse of vulnerable adults living in institutional settings. It will lay the foundation, for APS, law enforcement, health-related regulatory agencies, and the medical community for establishing investigatory protocols and intervention strategies as well as a for a model of prevention to address sexual abuse at local, state, and national levels.