Social Workers' Perceptions of Their Role in Committees for Preventing Elder Abuse within Nursing Homes in Israel: A Research Study

Numerous studies worldwide indicate that elderly individuals residing in nursing homes are at high risk for poor treatment. Despite the high prevalence, professional literature points to barriers that hinder the identification, detection, and reporting of this serious issue. 

In Israel, the Ministry of Health’s 2003 procedure for addressing elder abuse mandates the establishment of an institutional committee for handling abuse against elderly residents. The committee consists of a social worker, a physician, and a nurse, with the social worker serving as the committee coordinator. According to the procedure, the social worker, as the coordinator, plays a central role in identifying, detecting, and reporting abuse.

In light of the high prevalence of poor care in nursing homes and the barriers to detecting, identifying, and reporting abuse by both residents and staff, this research examines the experiences and perceptions of social workers in nursing homes regarding their roles as committee coordinators. It explores the difficulties they face due to these barriers and their strategies for coping with them.

This is a qualitative study based on a phenomenological approach. Data was collected through semi-structured questionnaires, aided by an interview guide, and included in-depth interviews with 15 social workers, serving as coordinators of abuse prevention committees in nursing homes. The interviews were conducted with social workers from nursing institutions of various sizes and from different geographic locations across the country. The analysis was carried out using a thematic analysis approach, focusing on identifying and understanding central themes, ideas, and recurring patterns in the participants’ experiences.

The content analysis led to three main themes. The first theme focused on the social workers' role perceptions as coordinators of the abuse prevention committees, which included five central role perceptions: the administrator, the expert, the democrat, the protector and rescuer, and the preventive role. These perceptions represent different approaches to performing the role, with one dominant role perception typically characterizing the social worker in their capacity as committee coordinator. However, social workers in this role may shift between different role perceptions based on professional, ethical, and environmental considerations, in order to address the challenges involved in abuse prevention work.

The second theme addressed the relationships and communication styles of social workers within the committee, identifying three main communication patterns: egalitarian, assertive, and confrontational. Each style reflected a different approach to discussions, decision-making, and conflict management within the committee. These patterns were important and effective tools, enabling the protection of residents' rights and ensuring appropriate care.

The third theme explored the challenges, conflicts, and barriers to detecting, identifying, reporting, and addressing abuse in nursing homes. It included two sub-themes. The first sub-theme discussed barriers to detecting and identifying abuse, such as the fear of residents and staff to file complaints, residents' dementia and cognitive impairments, and difficulties social workers face in defining and interpreting abuse. The second sub-theme dealt with barriers to reporting abuse, which included the conflict between the social worker’s duty to report and the administration’s desire to avoid harm to the institution, bureaucratic systemic obstacles, inadequate police handling of complaints, and the dilemma that reporting may harm an innocent employee.

The study presents a complex picture, which includes both significant achievements and numerous challenges faced by social workers in performing their roles. The findings indicate that social workers are capable of identifying and detecting abuse cases, raising awareness among care teams, leading significant processes to address the issue, shaping internal organizational policies, fostering collaborations, and influencing the handling of abuse cases in the institution. However, the research also highlights difficulties, barriers, and gaps between expectations of social workers and the reality in which they operate, particularly in terms of guidance, professional support, and communication with oversight and law enforcement agencies.

This study emphasizes the critical centrality of social workers in leading processes related to the protection of residents' rights and contributes significantly to understanding the role of social workers in advocacy and protection within nursing homes. Beyond its practical contribution, this research offers a significant theoretical contribution: it proposes a conceptual framework for understanding the role perceptions of social workers in institutional committees for the prevention of abuse, and deepens the discussion of role-related theories in complex institutional work environments.

The study's findings strengthen the need for further training, emotional support, and the development of clearer and more defined policies, both for social workers and for all committee members, in order to optimize the overall functioning of abuse prevention committees in nursing homes. Additionally, the research highlights the essential need for in-depth discussions with policymakers to improve care in the field of elder abuse prevention in nursing homes.