• ■KIHASA has published Issue & Focus, No. 407, ‘Elder Abuse in Institutional Settings in Korea and Its Policy Response.’
  
  

• ■Im Jeong-mi, an associate research fellow at the Center for Research on Aging Society of KIHASA, said, “The total number of counselling cases for elder abuse reported from 34 local senior protection agencies across the country rose twofold over 10 years to 5,243; in particular, the incidents of elder abuse in institutional settings including long-term care facilities have increased a whopping 9 times over 10 years.”
  
  

• ■“Elder abuse in institutions is occurring in various forms, from a single act to a repeated act occurring over a long period of time. Since it is a vulnerable population group--older adults who, having dementia, may lack ability to communicate their thoughts or whose physical incapacity requires constant care--who are victims of such abuse, it is all the more important for society to pay closer attention and make an active intervention,” she said.
  
  

• ■“Since the prevalence of institutional abuse announced by the Ministry of Health and Welfare and the Central Senior Protection Agency might have been underestimated as only a proportion of the cases were actually reported by the victims, it is highly likely that there are many more cases under the surface,” argues Dr. Im, adding that because institutional abuse comes in many forms and severity levels and thus no facility can rule out the possibility of an abuse incident occuring in it, there is an urgent need to carry out research into the scale and causes of institutional elder abuse.
  
  

The following is the summary of this report:

• ◆Elder abuse in institutional settings
  
  

• ■Institutional abuse is steeply on the rise and becoming chronic.
  - Table 1 shows that the number of cases of elder abuse has increased every year amid population aging, rising to record-high 617 cases in 2019 since it was first estimated in 2005. Institutional abuse made up 11.8 percent of the total elder abuse cases in 2019, up from 2.7 percent in 2009.

Table 1. Cases of elder abuse in institutional settings by year (unit: percent, case)

- In types of abuse, ‘neglect’ has consistently made up the highest proportion with its occurrence gradually increasing from 99 cases in 2012 to 352 cases in 2019 (Table 2.)

Table 2. Types of institutional elder abuse by year  (unit: case)

• ■It was found out that abuse cases lasting ‘more than 1 month and less than 1year’ and those lasting ‘more than 1 year and less than 5 years’ have both increased greatly since 2012, indicating that abusive acts in institutions are becoming prolonged.
  - In contrast, in 2019 when the prevalence of elder abuse turned out to be the highest, ‘single abusive acts’ soared to 191 cases.
  - Institutional abuse cases were occurring in various forms, ranging from a single act of abuse to repetitive abusive acts lasting for a long period of time.

• ◆Careworkers’ Witness of Abuse in Institutions

• ■A survey of 312 careworkers at 60 different care facilities has shown that when it comes to a particular abusive act, a low of 2 percent to a high of 40 percent of careworkers have  said they have witnessed it.
  - These careworkers have witnessed many incidents of neglect such as ‘ignoring the residents’ requests,’ or ‘not meeting the sanitation level required by the residents’; or they have witnessed high incidents of psychological abuse such as ‘shouting at the residents in anger’ or of physical abuse such as ‘excessively restraining the residents.’
   

• ◆Causes of elder abuse in institutions and their countermeasures
   

• ■In order to prevent elder abuse in institutions that might occur routinely and chronically, above all, we should identify the causes and their countermeasures.
  - The physical limitations, functional dependence, and cognitive disability of elderly residents are reported as risk factors for abuse as they increase their dependence on care staff and  stir the staff’s aggressiveness.
  - Another group of risk factors includes care facility staff’s low awareness of human rights or abuse, lack of training in care skills, lack of general education, stress, burnout, or emotional exhaustion.
  - Lack of manpower at facilities, excessive working hours, a low ratio of staff to residents, a group culture that tends to cover up abuse, or a culture of acquiescence or approval of abuse are found to affect care staff to be abusive.
  
  

• ■ For the prevention of elder abuse in institutions, several measures were recommended by survey respondents that might bring about changes in organizational and legal frameworks, including ‘training and education of careworkers in care skills and on dementia (30.0%),’ ‘peer counselling for stress (9.9%),’ ‘strengthening staff support and instituting in care facilities a rapid reporting system (10.1%),’ ‘increasing care manpower (18.0%),’ and ‘ensuring strict punishment for abuse perpetrators (10.3%).’

• ◆Conclusion

• ■As elder abuse in institutions is more likely to be perpetrated by their staff, to prevent it, it is very important to provide support to them. In addition, as institutional abuse is caused not by a single factor, but by a complex entanglement of several factors, parallel changes should be made in legal and institutional systems.
  
  - First, there is a need to create a care environment where careworkers can take a break from a situation where abuse may occur to take control of their anger or aggressiveness. Also, it is recommended to expand peer counselling programs or careworker support programs to help them relieve stress or burnout.
  
  - Second, it is necessary to expand the training and education of careworkers in their care skills, and to expand the workforce to share the workload.
  
  - Third, because of a group culture that conceals and tolerates abusive acts, institutional abuse can develop from an abuse of relatively low severity to a serious one. So, it is important to bring change to the culture of care institutions so that abusive incidents or accidents can be promptly reported to the relevant authorities and that measures can be implemented to prevent a recurrence.
  
  - Fourth, the management and supervision by local governments should be enhanced to prevent the recurrence of abuse in the same facilities.