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| Abuse complaints in nursing homes are rising.Pixabay | File photo |
(Editor’s
note: This story has been revised to remove the current name of a
nursing care facility because the incidents that were reported there
occurred under a previous owner.)
The
incident in a bathroom at a nursing care facility in Morris County
involved a confused and disoriented nursing home resident who would not
get up from the toilet.
According
to a federal inspection report, the unidentified patient required
“extensive assistance” in most daily activities and a nurse’s aide asked
for help from another aide, who stood over the resident and immediately
turned to physical force.
"The
abusive CNA (certified nurse aide) began to pull the resident’s hair
and pull the nipple on the resident’s breast to get the resident to
stand up,” inspectors said.
No one reported what happened for five days. The aide who witnessed it had been “afraid” to step forward, investigators said.
Nursing
home abuse is an often-hidden secret in many of the places that
families trust to take care of their elderly. At times unnoticed by
overworked and frequently overwhelmed staff who may miss or simply
ignore maltreatment by others, abuse in long-term care facilities
typically has few witnesses. Victims with minds clouded by dementia
often are unaware of how they received bumps, bruises or even broken
bones.
But
a NJ Advance Media analysis of federal nursing home inspection reports
filed with the Centers for Medicare and Medicaid Services shows
abuse-related citations nationwide are on the rise, jumping to 4,107 in
2018, up from 3,083 in 2016.
It
is likely just the tip of the iceberg, advocates say. A report in June
by the Office of Inspector General for the U.S. Department of Health and
Human Services said nursing homes fail to report nearly 1 in 5 of
potential cases of abuse.
In
New Jersey, there were about 30 complaints investigated by federal
regulators last year involving abuse allegations, most calling out a
facility’s failure to quickly notify the state Department of Health.
Yet
that was only a small fraction of the 353 complaints just for physical
abuse alone reported last year to the state through a hotline maintained
by New Jersey’s Long-Term Care Ombudsman. Laurie F. Brewer, the state’s
ombudsman, believes the actual number of incidents involving abuse and
neglect in the state are “dramatically” undercounted. Some residents are
reluctant to report any problems, she explained, fearing retribution.
“You
are in the most vulnerable position in your life at the end of your
life. People are fearful of reporting, especially people who don’t have
family members,” she said. “It’s heartbreaking. The thousands of people
who don’t have regular visitors or have friends who come visit them,
they are the most vulnerable.”
Roosevelt
Care Center at Old Bridge, for example, was cited earlier this year for
failing to report incidents of altercations between residents to the
N.J. Department of Health. The April report detailed a number of
physical attacks by a nursing home patient who hit, kicked and scratched
other residents, staff and visitors.
But
there were reports of outright intimidation or deliberate mistreatment
of residents by workers — as well as assaults by agitated residents —
deemed to represent "immediate jeopardy” to the health or safety of
those living there.
Among
them included Riverside Nursing and Rehabilitation Center — whose
owners also hold an interest in the troubled Wanaque Center for Nursing
and Rehabilitation in northern New Jersey where 11 children died in a
viral outbreak last year. The Trenton nursing home, ranked at the bottom
by federal regulators as “much below average” in both overall and
health inspection ratings, was cited for abuse deficiencies in a 2016
report.
According
to that report, a resident was forcibly held down and dragged down the
hallway and away from the nurse’s station, all while the individual was
yelling and thrashing on the floor. The episode was caught on
surveillance video. A unit manager walked away and could be seen
throwing her hands up in the air. A nurse’s aide later said she was
frustrated with the resident, who she said was very difficult to care
for, the report said.
And
in another 2016 incident at the nursing care facility in Morris County,
an unidentified nurse aide reported the abuse of a resident in the
shower. According to the federal report, inspectors recounted “the
resident was yelling, and the abusive CNA (certified nurse aide) began
hitting the resident and grabbing the resident’s face. The CNA who was
assisting the abusive CNA in the shower stated that the resident
screamed because of the cold water, but that the abusive CNA slapped the
resident’s face and held the resident’s mouth shut.”
An
earlier version of this story gave the current name of the facility
where these incidents occurred. That name has been removed because the
facility was being operated under a different name by a previous owner
at that time.
Riverside Nursing officials in a statement said they responded as soon as they learned of the abuse allegations.
“When
notified of this regrettable incident from three years ago, management
immediately terminated all personnel involved for not following our
standard of care and staff received additional training," said Daniel
Engelson, the administrator of the nursing home. "This incident does not
reflect the level of professionalism of our staff.”
Middlesex
County, which operates Roosevelt Care Center in Old Bridge, said the
nursing home was not cited because of deficiencies in intervention or
quality of care, but because the incident between two residents was not
reported in a timely manner.
“The
quality of care and staffing at Roosevelt Care Center has been deemed
above average by the state, which has issued high marks to the Old
Bridge Roosevelt Care Center in this regard,” said a county official in a
statement. The county has taken corrective measures following a review
related to the handling of reportable incidents.
ABUSE NOT REPORTED
Nationwide, the inspector general’s report for the Department of Health & Human Services found that estimated one in five high-risk hospital emergency room Medicare claims for treatment in 2016 were the result of potential abuse or neglect, of beneficiaries residing in a nursing home.
Despite
those injuries, many of the incidents were never reported by the
nursing homes to regulators, the report revealed. And findings of
substantiated abuse were often not reported to local law enforcement as
well.
In
a New Jersey case garnering national headlines in 2011, the family of a
paralyzed, 87-year-old woman beaten by an aide at a North Bergen
nursing home only learned of the incident after it was captured on a “nanny cam”
they had left in her room at The Harborage Nursing Home after seeking
several suspicious bruises on the woman’s body. The video images shows
an aid striking Modesta Alvarado in the head two or three times, and
violently removing her oxygen mask.
The aide, Julia Galvan, later pleaded guilty to charges of assault. According to court records, she received probation.
“Elder
abuse and neglect is a serious problem, with the elderly population
expected to reach approximately 84 million by 2050,” said the inspector
general in its recent report, noting that a 2008 survey, 1 in 10 elderly
persons reported emotional, physical, or sexual abuse or potential
neglect. “However, many cases are not reported because the elderly are
afraid or unable to tell protective services, police, friends, or
family.”
In a separate report last week, the Government Accountability Office found that the number of abuse citations in nursing homes,
while relatively rare, doubled from 2013 to 2017. Physical, mental or
verbal abuse was most common, followed by sexual abuse. The perpetrators
were often staff.
The
GAO report, however, said there are gaps in the reporting process.
While federal law requires nursing home staff to immediately report to
law enforcement and the state any reasonable suspicions of a crime
resulting in serious bodily injury to a resident, there is no equivalent
requirement that the states make timely referrals for complaints
received either directly or through surveys.
FEARS OF RETRIBUTION
State
Health Committee Chairman Joseph Vitale, D-Middlesex, who led a
legislative hearing into the failed response of the Wanaque Center
following last year’s viral outbreak, noted that abuse victims are
typically unaware of their rights, don’t have the wherewithal to file a
complaint, or are just afraid to say anything.
“It’s the same as domestic violence and sexual abuse. How many incidents are reported?” he asked.
The ombudsman’s office has an army of about 220 volunteers
whose job it is to spend four hours a week visiting the state’s more
than 360 nursing homes. They help prevent bad things from happening,
said Brewer.
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| Incident of abuse and neglect in N.J. are “dramatically” undercounted, advocates say.Pixabay | File photo |
A
hotline takes in thousands of calls a year. The overwhelming number of
them come not from nursing home residents, but are made by family and
friends, workers and former staff members.
If
the office suspects a resident has been the victim of abuse, the
findings are referred to a regulatory or law enforcement entity for
possible further action.
Most complaints almost always circle back to inadequate staffing, Brewer said.
“The
better staffing ratios, the better the outcomes for residents. It feeds
into everything else.” If not enough aides are working, the more likely
that people won’t get timely changes, or (the nursing home) won’t
follow the care plan. Mistakes will be made,” she said.
Abuse
is not always about bad people working in nursing homes, but rather
about poorly trained, under-supervised or overwhelmed people, said
Stephen Crystal, a researcher and professor of health policy at Rutgers
University. He, too, saw the dividing line between poor care and abuse
as most likely tied-in to staffing.
“The best thing we can do to cut abuse is mandate better staffing,” he said.
At
the same time, though, Crystal added that not only are those in nursing
homes requiring more medical attention than in the past, but new
efforts to restrict the use of anti-psychotic drugs — which are
especially dangerous for elderly patients — means more nursing home
residents are acting out. That, too, requires more and better-trained
staff, he said.
Abuse, meanwhile, is not just about violence toward a nursing home resident, said James McCracken, president and CEO of LeadingEdge New Jersey, the statewide association of not-for-profit senior care organizations.
“It
can range from neglect, which is a professional’s failure to meet
standards of practice, all the way up to the physical stuff,” he pointed
out.
What’s
important, said McCracken, who served as the state’s Ombudsman for the
Institutionalized Elderly, is those providing senior care services
ensure they screen their employees, do good orientation and provide good
continuing education, to make sure they are hiring care givers.
“That’s the kind of person you need to provide compassionate care,” he said.
Full Article & Source:
She was pulled off the toilet by her hair. Often unreported, nursing home abuse on the rise.
