Dissertations, Theses, and Capstone Projects

Date of Degree


Document Type


Degree Name



Social Welfare


Nancy Giunta

Committee Members

Daniel Gardner

Elizabeth Capezuti

Subject Categories

Social Work


elder abuse, home health aides, identification of elder abuse, reporting of elder abuse, motivation to report elder abuse, theory of self determination


Elder abuse impacts close to 13 percent of older adults in the US. It exists in secret, with only about one in 24 cases becoming known to the systems that can provide intervention. As baby boomers age and the general population lives longer, for example New York City is expecting to have up to 1.3 million adults by year 2030, the number of people impacted by abuse is expected to drastically increase. A gap exists in the current span of knowledge and practice applications about the issue, particularly around homecare services. Home health aides, a rapidly growing profession, provide direct and often intimate care, leading to development of trusting relationships, which may lead to disclosure of experienced abuse. This cross-sectional, exploratory study utilized Grounded Theory methods to learn about the intrinsic and extrinsic facilitators and barriers to detecting and reporting elder abuse among home health aides in New York City. The two aims of the study were to learn about the extent of the aides’ knowledge about elder abuse and to explore their motivational factors regarding its reporting. The Self- Determination Theory, which establishes motivation by presumed satisfaction of three psychological needs: autonomy, competence and relatedness provided a theoretical orientation to this study. The purposive sample consisted of 17 certified home health aides working with older adults in licensed home care agencies. Data was collected via semi-structured interviews conducted in English. The two main identified themes were “Elder abuse is multidimensional” and “Personal, organizational and economic drivers influence reporting”.

The participants’ responses mirrored the well documented lack of universally utilized definition and their knowledge about the issue was stated to have been obtained from multiple sources, including personal experiences of caregiving for family or friends. The motivation to report abuse was expressed as a moral obligation with the barrier described as potential negative consequence. The facilitator to gaining knowledge about elder abuse, as well as motivation to report, was found to be largely intrinsic in nature. The extrinsic motivator, the participant identified quality of connection to the home care agency, seems in turn to have the potential to be either the facilitator or a barrier. The findings suggest an opportunity for minimizing barriers to identifying and reporting elder abuse by home health aides.

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