I think most of us approach the idea of sharing the care of an elder with a lot of trepidation. We have cared for them with one-on-one loving attention. We know their history, their preferences, their tempers and their needs. Bringing others, no matter how experienced, into the equation is counter-intuitive.

However, for many of us, the time comes when we have no choice. Over the course of two decades I cared for seven elders. All but two spent some time in a senior living facility -- whether it be an assisted living community or a nursing home During the 15 years I visited daily, I saw three changes of ownership. Each was good, though the last (and present ownership) has been the best, from the viewpoint of a family member.

Dad was the true heart-breaker. He had surgery for complications from a World War II brain injury. Not only did the surgery fail, it put him into a paranoid dementia and introduced a voice in his head who we came to call Herman. The shock of his personality change after the surgery is indescribable. His emotional and psychic pain was one of the worst things I've had to bear. He survived this way for 10 years.

When Dad went into the same nursing home as my uncle (and eventually the rest of my elders), we watched the home closely. He was so terribly vulnerable, and we felt helpless in the wake of the changes. Yes, we knew the home was excellent. We knew most of the staff, as my uncle had been there for years. However, dad was on a different floor with different staff.

And this is where I went wrong. There was a male CNA on the floor who worked nights. Dad started talking about how rough the person was when he cared for dad at night.  We knew by then that Dad hallucinated and went in and out of paranoia. So, we were quite careful about taking everything he complained about too seriously. Still, nothing he said was ever taken lightly. We always were aware that he could be right.

I began talking with members of other families who had loved ones on the same floor, and we kind of developed the "mob" mentality. Generally, I'm pretty mild mannered, but when it comes to protecting vulnerable people, I'm a tiger. And this was my extremely vulnerable dad.

When other people began agreeing with me that this CNA was too rough and that he maybe frightened some of the people, we agreed to write a letter to the administrator with all of us signing it. We felt that was the right thing to do.

That is something I still regret. I don't regret my vigilance. I do regret not going through proper channels. As it worked out, this man became one of the best aides in the home, and I can't tell you what his care for my mother meant to me after Dad died and I had to handle all of the logistics, plus the emotions, and my mother's upset. He was a gift from God. And yes, he knew I was one of the people who signed that letter years before.

But I will back up a bit. The administrator answered the letter kindly and talked with us all. He told us that the man had been warned to be more careful, and he was temporarily moved to a different floor. But the administrator did say he wished we'd talked with him before we wrote the letter. Because of the way we handled it, the complaint had to be reported to the state and everything was much more serious for this very good home – and for a man who, it turned out, was a very good caregiver – than it needed to be.

We, the families, certainly meant well. We wanted the best care for our loved ones and we didn't want to take a chance if there was any abuse. But we overreacted. One thing I've since learned is this: we families want, in our hearts, one-on-one care for our loved ones. We want their call light to be the first answered. We want every need met. And we, the loving families, are very unrealistic. Unless we have the funds for a private nurse 24 hours a day, our loved ones will not get number one priority all the time. These CNAs and nurses have many people to care for, and sometimes, well, Mom may have to wait. That is life.

I want to be very clear, however, that elder abuse can occur. It happens. There is neglect. That happens even more often. And very often, the understaffed centers are overworking their aides because they have no choice. The pay is low. The work is hard. And not everyone is suited to the kind of work they must do. So, understaffing is a huge problem and vigilance on the part of the family is important.

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My feeling about this man was that he was pressed for time. He happened to be a physically large man, tall and strong, and perhaps when he hurried he seemed rough. I learned through the years that he very was kind and gentle. Did our complaint help make him so? I think he was like that all the time, but perhaps the ordeal made him more aware of how he approached people.

What should we have done? We should have taken a deep breath and gone through the proper channels. In this case, we should have started with the floor nurse.

4 Steps to Take When Reporting Abuse

  1. If possible, talk nicely with the CNA or hands-on person you think may need some direction. Talk kindly, and take some of the load off by saying, "Mom can be sensitive, and I know that. Is there a better way we can handle this?"
  2. If you don't get anywhere with that (all of this advice only applies if there isn't obvious abuse – if that is so, skip to the last step), talk with the floor supervisor, often a nurse.
  3. If that still doesn't get you a listening ear and some change – and if you are being realistic about your requests – then talk with the home administrator.
  4. If talking doesn't get you anywhere, write a letter and state the complaint and say that you will be contacting your state ombudsman. An ombudsman is an independent advocate who handles consumer complaints about government-regulated agencies. Since nursing homes are government-regulated agencies, they qualify. Assisted living centers may not, but it's worth a try. Then do so. You can go online to your state's website and look up aging services or you can go to the national site and find the National Long Term Care Ombudsman Resource Center. You will then type in the location of the home and you will find contact information. Carry through, and this person will investigate.

Don't ever be afraid to involve the ombudsman. That person is there for the families and is not affiliated with any homes. This is your right. But often, as in my case, things can and should be settled by going through the proper channels within the home. Most of the time the people in the facility want to do a good job. They may not even be aware of any problem.

One reason references for care centers are not always reliable (though I still recommend checking them) is that what one person thinks is great, another thinks is terrible. People have different expectations. Our problem with this CNA was passion for our elders and the feeling of powerlessness. Acting the way we did made us feel like we had some control even though we weren't with our loved ones all the time. We weren't mean spirited or too demanding, but we were not educated in getting the best care for our elders.

Making friends with the staff – which I did over the years – is very helpful. Let them get to know you. Let them know that you aren't demanding the stars and the moon, but that you are consistently visiting and want the best care possible for your loved one. Let them know that you, or someone you can trust, will be available to assist them. That friendly partnership type of attitude will generally get you farther than a demanding, adversarial, contrary attitude can.

However, the bottom line is this: If there is any suspicion of abuse or neglect, look into it. Depending on the severity, follow the steps and go up the chain of command. Take a moment to discuss the problem with someone who is more detached from the situation than you, so you can know your aren't being over-emotional. If there is obvious abuse, go right to the state level and find the ombudsman in your area. Or call the county officials. Keep in mind that you are the one who will ultimately make the decision, but try to do so armed with realistic expectations balanced with an educated approach.