One after another, newspaper articles and reports on the quality of care in our nursing homes and eldercare facilities in Aruba continue to show a painful reality: cases of abuse, neglect, and lack of proper attention are the order of the day.
As president of the Alzheimer Foundation Aruba (F.A.A.) and the project “No Excuse for Elder Abuse” / “Bisa No Abuso di Adulto Mayor”, I severely question the statements made in the press by the relevant Minister of Health. The Minister insists that “abuse has always taken place,” even among parents and children at home “where blows also happen.” It seems as if trivializing these calamities is a standard modus operandi that happens everywhere in the world. This message from the Minister is completely reprehensible, and F.A.A. considers this mindset of the Minister to be an enormous disrespect to our community and certainly to our senior citizens.
Our senior citizens deserve better! They depend on and deserve a management approach that serves their dignity, safety, health well-being, protection, and supervision of their human rights, backed by strong laws and protocols for protection and oversight against financial abuse, physical abuse, or neglect.
This response is NOT what the public expects from a public official who must shoulder and demonstrate responsibility for the health and well-being of the elderly. Nor are these answers a justification for inaction. The Alzheimer Foundation Aruba demands an immediate investigation into the calamities in care homes and a zero-tolerance policy to protect senior citizens without exception.
Management for optimal care in nursing homes should NOT just consist of reading and commenting on abuse reports, but also acting in such a way that the amount of abuse decreases drastically and genuinely. Among other things, this means actively introducing firm rules to prevent elder abuse in all sectors that provide services to the elderly. Acting actively involves a mindset shift toward an efficient, realistic, and sustainable management approach. Below are several points that could contribute to transparent management and the prevention of elder abuse, such as making intensive use of existing laws concerning the fundamental rights of senior citizens in treatment and care:
*Quality of Care: Guaranteeing a high and safe standard of medical and personal care.
*Safety, Protection, and Supervision of Patient Rights: Protecting and respecting legal rights to participation, privacy, and personal freedom (including abstaining from physical and mental restraints) and drastically reducing the risk of errors, falls, and/or neglect by using fixed and mandatory protocols.
*Guaranteeing Medication Safety for the Patient (medicatieveiligheid) and Preventing Errors, especially fatal ones. It is important to ensure that care homes comply with strict quality requirements under law and international protocols regarding medicines. Control over the staff responsible for dispensing medication is indispensable. The practice must be that only nurses or trained personnel are allowed to distribute and administer medicine—something that here and there is STILL not the case. Another essential point is protecting seniors from side effects/toxic effects and polypharmacy (the use of many medications simultaneously, which may have contradictory consequences). There are seniors in care homes taking more than 5 different medications per day (note: 5 or more medications already fall under the standard definition of polypharmacy). Oversight is necessary to prevent dangerous interactions between medications. More rigorous controls are also urgently needed here due to the high risk of falls and confusion.
*Inspection and Control: It is important to regularly use the legal and existing instruments of the independent body (IVA) to monitor and punish irregularities, including direct financial sanctions for care homes that fail to comply with the law, and in serious and unacceptable cases, revoking operating licenses as prescribed by law. In Aruba, these laws exist and are enforced, but they are NOT strong enough to reduce the number of calamities/abuses in care homes. On the contrary, figures from this year even show an increase in calamities.
*Active and Surprise Inspections: It is necessary for the Health Inspectorate (IVA) to increase the frequency of unexpected and regular visits, especially during night shift handovers and weekends when oversight is lower.
*Legal Framework and Strict Quality Norms (Staffing Ratios) in Care: Structuring by law the maximum number of patients per caregiver and care home (per square meter). Much abuse and neglect happens because workers (qualified or not) face excessive workloads and job stress.
*Compliance with Legal Building Safety Standards: Against fire hazards, hygiene requirements, and modern ergonomic care standards.
*Mandatory Certification: Control over all supervisors, caregivers, and employees of these homes, as well as home care service businesses in the community, and legal (recognized) certification/diplomas to function in geriatric care and domestic work.
*Strict Screening: Requiring a Certificate of Good Conduct (VOG) specific to elder care before hiring someone (it is not enough for someone to have only done housekeeping or cared for a relative before), including their ability to adapt to and knowledge of the senior’s culture and language.
*Public Quality Register: A public rating system for each care home based on inspections so the public can feel safe and know which homes provide good care and which ones have a “red flag.”
*Training in Cognitive Conditions: Mandatory, certified, and continuous courses on, among other things, how to treat and understand a person with a (neuro)cognitive condition (not just “Alzheimer’s” or “dementia”), limiting the structural use of force, abuse, and sedatives as much as possible.
*Family Involvement (Mandatory Committee): It is urgent to require every care home to have an active board or committee of family members with a voice in the institution’s decisions and oversight. A lack of involvement from family or a significant person in the senior’s life is a primary cause of abandonment and failure to visit loved ones in care homes.
*Presence of a Spiritual/Emotional Guide (e.g., social worker, pastor, etc.): The presence of a spiritual guide or professional to communicate about how the senior and their family handle the illness, its limitations, acceptance, and coping strategies. For this, every care home needs a safe room where care can be discussed with the family and/or doctor/professional alongside the senior themselves (if possible) in a private setting.
*Transparency and Anonymous Protection (Whistleblower): A telephone line (e.g., 3 digits) or digital platform where family members, visitors, or staff can report suspected abuse while being structurally protected against retaliation.
Conclusion: Protection against calamities/abuse in elderly care, both in nursing homes and in their own environment, demands fundamental changes in the management of fundamental senior rights and the adaptation of laws! These changes are indispensable for a drastic reduction in the amount (visible and hidden) of abuse in care homes and in general!
Aruba does not need more care homes with little or no knowledge of elder care; nor does Aruba need to import more foreign workers (with a culture different from that of the patient and their frame of reference) into care; nor does Aruba need pretty words or promises of more reports and investigations that disappear into a drawer after a government change. What Aruba needs is a Minister with vision and legislative determination to change the scenario of mismanagement in the care of our senior citizens. This applies to institutions providing care services (including private care homes, hospitals, clinics, companies/private care providers and/or home cleaning services, pharmacies, day-care centers). In short, any service dealing with physical and mental care concerning the senior citizen.
Management in general must transform from a passive role to one of strict control and severe sanction, especially when human lives are at stake. For this to happen, the Inspectorate (IVA) must have more tools, “real” power, and more subsidies to act forcefully, thereby ensuring that care homes, the home, and the senior’s community are places of peace, dignity, respect, and safety. Our elders deserve management where their safety, health, and well-being are central!
To provide the best care and peace of mind to our seniors, such management must focus on at least the following key points:
*Safety and protection with “teeth-bearing” laws to penalize physical, mental, and financial abuse; regular and unannounced inspections by the Inspectorate (IVA) in care homes; and harsher sanctions such as heavy fines or the closure of negligent institutions that do not comply.
*Official registry to report and legally track suspected abuse.
*Community safety for those who prefer (or choose) to live at home.
*Fair, standardized quality of care.
*Staff with correct knowledge of geriatrics. Continuous local training for care workers. Rewarding healthcare students returning to Aruba with pay matching their earned diploma level (instead of cheap labor).
*Individual care plans based on respect, dignity, and local culture.
*A structured fund to guarantee materials, medicine, adequate infrastructure, subsidies for care, healthy food, and mobility for prevention (wheelchairs), all focused on those with lower income.
*Well-being and Mental Health: motor activities, physiotherapy, etc., to prevent inflammation, falls, depression, etc., and to combat loneliness at home, day-care centers, and nursing homes.
*Specialized psychological care for seniors and their families, and family integration to keep social and emotional bonds strong.
Successful management requires structural cooperation between the government, care institutions, and the entire community. To achieve management based on research, one must rely on reliable research conducted in recent years rather than paying every 4 years for a new study. Yesterday’s abuse reports must serve to prevent today’s abuse! Our elders who worked for this country deserve nothing less!
In a subsequent article, F.A.A. will expand on the Madrid International Plan of Action on Ageing (MIPAA), adopted by the United Nations in 2002, which is the most urgent and important global framework to ensure that older adults can live with dignity. However, when the factor of disability comes into play, vulnerability is doubled, which often leads to (mostly invisible, even normalized) violations of their basic human rights.