When Susan visited her father, Mr. Stacey, in the nursing home, he looked unkempt and smelled dirty. She'd never seen him like that! He wasn't always lucid so she didn't quite know what to think when he told her he would no longer take showers. Susan met with the lead nurse and the consulting doctor but neither could offer any medical explanation for her father's change in behavior. She insisted that the attendants resume helping her father take a shower every other day.

The next day a new attendant took Mr. Stacey for his shower without incident. After the shower, Mr. Stacy asked her when the water got fixed. Upon further questioning, he explained that for the past several weeks when the usual attendant helped him with his shower the water had been so cold he almost passed out.

The new attendant reported his description to the lead nurse who called in the usual attendant. When confronted with Mr. Stacey's report, the attendant admitted using only cold water for Mr. Stacey's showers to punish him for being mean. The attendant claimed that Mr. Stacey soiled his pants on purpose when she was working so she was teaching him a lesson.

What does this case teach us?

• Abuse of the elderly occurs in nursing homes, assisted living programs, home-health care, and adult day care. They are especially vulnerable.
• Workers in these programs may lack the skills and information they need to understand the complex problems these clients present.
• Staff interactions with clients require vigilant monitoring.