Unreported Abuse NYT Mar 3, 2002

March 3, 2002

Unreported Abuse Found at Nursing Homes
By ROBERT PEAR- NY Times

WASHINGTON, March 2 — Physical and sexual abuse of nursing home residents is not being promptly reported to local authorities and is rarely prosecuted, federal investigators say. In a new study, the General Accounting Office, an investigative arm of Congress, says, "Nursing home residents have suffered serious injuries or, in some cases, have died as a result of abuse." Existing safeguards are clearly inadequate, the report says, since more than 30 percent of the nation's nursing homes have been cited by state inspectors for violations that harmed residents or placed them in immediate jeopardy.
The accounting office conducted an 18-month investigation and plans to present its findings on Monday at a hearing of the Senate Special Committee on Aging, headed by Senator John B. Breaux, Democrat of Louisiana. The report says workers who abuse patients in one state can often be hired by "unsuspecting nursing homes" in other states because the states do not exchange information and there is no national list of workers who have abused patients.
The inspector general of the Department of Health and Human Services recommended such a national registry in 1998. Medicare officials are still studying the feasibility of the idea, the report said.
About 1.6 million people live in 17,000 nursing homes nationwide. Medicaid and Medicare help pay for three-fourths of the patients and spent $58 billion for their care last year.
The General Accounting Office found that "alleged physical and sexual abuse of nursing home residents is frequently not reported in a timely manner," and that "few allegations of abuse are ultimately prosecuted." Even when charges are brought, some frail and elderly victims die before a trial can be held, the report said.
The federal investigators said they had found several reasons for the delays: Patients and their relatives are often reluctant to report abuse, because the patients fear retribution and the relatives fear the patients will be told to leave.
Nursing home managers are reluctant to report abuse because they fear that it will cause "adverse publicity" or that state regulators will impose fines and other penalties.
Nursing home employees "fear losing their jobs or recrimination from co-workers" if they report abuse.
In some states and at some nursing homes, it is difficult to learn the correct telephone number for reporting abuse.
Nursing homes rarely incur any penalty for failing to report abuse, the report said.
Investigators from the accounting office reviewed records and interviewed officials in Georgia, Illinois and Pennsylvania. Police officials in all three states reported that they were "seldom summoned to a nursing home following an alleged instance of abuse," the study said.
The report's findings were borne out in interviews with relatives of several nursing home residents around the country. Violette King, 58, said that her father, Louis H. Papagianis, 85, had been abused by a nurse's aide at a nursing home in an Illinois suburb of St. Louis. Mrs. King said she found her father with bruises, scratches and cuts on his arms, neck and cheek and behind his ears. "Other nurse's aides reported the abuser to the nursing home administrator," Mrs. King said, "but nothing was done for eight or nine months. I filed a complaint. The Illinois Department of Public Health held a hearing. The abuser eventually lost her right to work at nursing homes in Illinois, but I understand that she's now working across the river in Missouri." Mrs. King said: "My father had become combative. Now I understand why. He was trying to save his own life."
In another case, Barbara A. Becker, 54, of Evansville, Ind., said her mother-in-law, Helen M. Straukamp, 83, had been fatally attacked by a patient while living in a nursing home. "My mother-in-law was standing in a hallway," Mrs. Becker said. "A male patient came down the hall behind her, cursing at the top of his lungs. When she turned around, he grabbed her by the elbows, lifted her off the floor and slammed her into a wall. She fell to the floor unconscious. "The nursing home sent her to a hospital emergency room, but there was no mention of the assault in the records that went to the hospital. The case was described as a fall. An employee at the nursing home later told us what had happened."
New York appears to be more aggressive than many states in prosecuting those who abuse nursing home residents. Since January 1999, the Medicaid fraud control unit in the office of the state attorney general, Eliot L. Spitzer, has filed charges of patient abuse against 86 people. Kevin R. Ryan, a spokesman for the unit, said that 60 people had been convicted and nine had been acquitted, while two cases were dismissed and the others are pending.
Elizabeth B. Dowdell, an assistant professor at Villanova University College of Nursing in Pennsylvania, studied 20 cases in which nursing home residents had been sexually abused. "Many of the victims suffered in silence," Ms. Dowdell said. "The assault became known only after evidence or suspicious clues were noted by family members or nursing home employees."
A Tennessee man was recently sentenced to three months in jail after he pleaded guilty to one count of sexual abuse. While working as a shift supervisor in a nursing home, the man had sexually assaulted a male resident, the Tennessee Bureau of Investigation said.
Law enforcement officials in other states reported several cases of physical abuse. The attorney general of Vermont, William H. Sorrell, said a nursing assistant pleaded guilty last summer to one count of abusing an elderly, disabled resident of a home in Burlington. The employee had slapped an 82-year-old man, who had Alzheimer's disease, across the face.
In Maryland, a nursing assistant pleaded guilty to one count of assault last August. The defendant acknowledged that she had attacked a woman who was a resident of a Baltimore nursing home. The victim, who was severely disabled and used a wheelchair, had been repeatedly hit in the face.
The General Accounting Office gave this example of the problems it found in many cases: "A resident reported to a licensed practical nurse that she had been raped in the nursing home. Although the nurse recorded this information in the resident's chart, she did not notify nursing home management. She also allegedly discouraged the resident from telling anyone else. "Two months later the resident was admitted to a hospital, for unrelated reasons, and told hospital officials that she had been raped. It was not until hospital officials notified the police that an investigation was conducted."