The floor manager of a special nursing home for the elderly in the western Tokyo city of Ome was assisting a 93-year-old resident in the toilet one afternoon when he noticed a bruise near her elbow.

He immediately alerted the director of the facility, called Ayumien, that a resident had been injured, telling Akihiro Fueki, 60, “It doesn’t look self-inflicted.”

As a result of the Sept. 14 incident, another staff member asked the woman for permission to check her body for other injuries and found she was bleeding under the skin on her chest and thighs, as well as on the pit of her stomach.

She asked staffers not to say anything because she did not want to cause a fuss.

The resident seemed to be in pain and having difficulty eating but was reluctant to divulge details of the assault.

But as she talked with staff, the woman let slip that she was hit. However, she refused to name the individual.

“I couldn’t believe it at first,” Fueki recalled.

Fueki urgently summoned the staff members assigned to the floor where the resident stays, but the culprit did not come forward.

When the woman was checked by a doctor at a hospital, it emerged she also had a broken left rib and damaged biceps.

The following day, the director reported the case to city authorities, saying the resident had clearly been subjected to physical violence by one of the staff.

When Fueki interviewed them again, it transpired that a man in his 20s who worked the late shift on Sept. 13 had struck the woman.

Drooping his head out of a sense of shame, the man said he got frustrated when the woman requested his urgent assistance to use the toilet.

His supervisor told him to stay at home until the matter was sorted out.

Fueki notified police on Sept. 16 and visited her family members to apologize for the incident.

Police questioned the man and arrested him. In October, he was summarily indicted for assault.

The incident left Fueki wondering what additional steps could be taken to ensure such violence never happens again.

The social welfare corporation that operates Ayumien had compiled a checklist of 15 inappropriate care practices.

The questions include: “Do you treat residents in an intimidating manner or talk to them in a commanding tone?” and “Do you tell residents to wait a minute too often and make them wait for a long time?”

The checklist was shared among staff members during training sessions and on other occasions and has also been adopted by other nursing homes.

Still, the assault on the 93-year-old woman took place. Fueki felt the checklist was not a panacea and needed to be revised based on opinions from front-line workers.

He interviewed 10 or so residents to ask how they were treated by staff.

They all replied that on occasion they were addressed in strong tones and treated roughly.

Fueki held more discussions with the staff to get a greater insight on the difficulties of providing sufficient care, especially when a lone worker is responsible for 24 or so residents during the night shift.

As a result, the facility introduced a training program offered by an outside instructor to help staff members control their anger.

Plans are afoot to install a monitoring camera in each room so staffers can respond quickly when a resident needs assistance.

Ayumien said it intends to introduce “nursing care counselors” dispatched by the municipality to strengthen the checking system from an outside perspective. The program aims to encourage facility operators to make improvements based on the opinions of residents.

The facility introduced a policy of restricting visitors after the novel coronavirus pandemic flared in early 2020.

The male staffer who struck the resident started working there during this period. This gave him fewer opportunities to meet with visiting family members watching over their kin or interact with family members.

“It is our role to support residents on behalf of their families,” Fueki said. “It appears he lost his temper and things escalated to the point where he used violent language and became physically abusive without giving any thought to the resident or her family.”

While anti-infection measures remain in place, Ayumien set up a space for visitors to see their family members. They can also watch through a window how staff members go about their duties.

“We will continue making efforts to prevent a recurrence based on input from our front-line workers,” Fueki added. “I want to tell our staff members that we must treat residents as people and provide care in a manner that is considerate to them and their families.”

According to a health ministry survey, reported cases of abuse of elderly patients by care workers at nursing facilities reached a record 739 in fiscal 2021, up 24.2 percent from the previous year.

Of them, about 20 percent occurred again at the same facilities.

Yoshito Kajikawa, who works to prevent elder abuse as head of a private research and training organization, observed that many staff members are exhausted and stressed out from the pandemic. He also noted that, in the current working environment, it is difficult for them to feel improvements in their working conditions. Those factors pushed abuse cases to a record. 

“Taking measures to prevent abuse need to be supplemented by placing importance on providing mental care for staff members and expanding the range of support available from external sources, including receiving nursing care counselors,” Kajikawa said.