How Fear of Retaliation Keeps Nursing Home Residents From Reporting Abuse

Richard J. Mollot, executive director of the Long Term Care Community Coalition

by Paige Cerulli

Elder abuse in nursing homes is a deeply troubling issue that poses a serious threat to the safety and well-being of residents. In June 2023, the Long Term Care Community Coalition (LTCCC) released a new report titled “They Make You Pay: How Fear of Retaliation Silences Residents in America’s Nursing Homes.” Using 100 government investigative reports on nursing homes nationwide, the report examines residents’ fear of retaliation by staff and offers valuable insights on the importance of creating a safe environment for senior care residents.

Here, we examine the report’s findings and discuss what nursing homes can do to create a safe environment where residents feel safe speaking up and reporting issues.

Creating the Report

The idea for the report was conceived by Professor Eilon Caspi, a researcher whom the LTCCC has worked closely with. Caspi also served as the principal researcher and previously served on the LTCCC board of directors. The report was released in honor of World Elder Abuse Awareness Day. “Empowering nursing home residents and their families is central to our mission,” says Richard J. Mollot, executive director of the Long Term Care Community Coalition, “so their ability to make their voices heard in their facilities has always been an important issue for us.”

Report Findings

According to the report, fear of staff retaliation “is a pervasive problem that results in emotional, psychological, and physical harm to vulnerable and frail individuals residing in U.S. nursing homes.” Fear of retaliation is also “a barrier for reporting, detecting, and investigating abuse and neglect in nursing homes.”

The 100 reports examined in the project detail threats of retaliation by staff and managers that were alleged and reported by residents. Types of threats included:

• Threats to delay or not provide services and care
• Threats of neglect and abuse to residents
• Threats of physical violence against residents
• Threats of retaliation if a resident reported sexual abuse
• Threats to discharge residents.

The report also includes descriptions of perceived staff retaliation against residents in response to residents’ concerns, grievances and complaints about care and mistreatment. The perceived retaliation includes neglect, delayed provision of care, psychological abuse, physical abuse, and resident rights violations.

Actual staff or manager retaliation against residents that has been confirmed was also included. This retaliation includes verbal and psychological abuse, physical abuse, and threats of physical violence.

The report findings, particularly the descriptions of the specific types of retaliation reported by individual residents, are eye-opening and difficult to process. Alleged threats include an incident where a staff member told a resident’s family that if they called state regulatory services, “it will be worse for the residents.”

Perceived retaliation included an instance where residents were cursed at and bullied after they complained about the food quality. Another report detailed an incident where staff didn’t respond to or delayed responding to call lights after residents voiced concerns and made complaints. In an instance of confirmed staff retaliation, a staff member told a resident, “You’re a liar and you’re messy” after the resident reported lack of hygiene care.

“I was surprised and very saddened to read the accounts of residents who were afraid – too often petrified – to speak out about a basic need,” says Mollot. “The federal nursing home law and standards, around which I’ve centered my career, all focus on providing resident-centered care and honoring the resident as an individual. It is painful to see the pervasiveness of violations of their humanity.”

Mollot highlights the fact that since the report focuses on a selection of survey reports, it is not meant to quantify the number of instances of retaliation fears in the country. “However, since these survey reports all contain findings that have been substantiated by state inspectors, it is chilling to imagine the extent to which fear of retaliation and retaliation occur which are not identified and substantiated and written up by state surveyors (who are only in a facility a few days a year and tend not to focus on emotional or psycho-social harm),” he says.

Effects of Retaliation

The report identifies several effects that retaliation has on residents. Residents reported many negative emotional consequences, including fear, anxiety, frustration, anger, sadness, and helplessness. Many residents felt that they were treated as “less than a person,” and their feeling of dignity was impacted. Residents feared that they would not be taken care of if they spoke up, and one resident reported that she feared for her life.

Physical consequences of retaliation included physical pain caused by assault, physical restraint, sexual abuse, neglect, and more. Fear of staff retaliation prompted many residents to avoid making complaints or filing care concerns.

How Nursing Homes Can Ensure Residents Feel Safe Reporting Issues

Given the report’s findings, it’s evident that nursing homes need to take additional steps to ensure they establish a safe environment where residents feel comfortable discussing their concerns and complaints.

Nursing homes can foster a safe environment by establishing clear and confidential reporting mechanisms that protect residents’ anonymity, thereby alleviating fears of retaliation. Likewise, providing regular education to residents about their rights and the reporting process is a crucial step in creating an environment where residents feel empowered to come forward with any problems.

Staff members should also be educated and trained on responding to issues. Staff should be trained in recognizing the signs of abuse, the importance of reporting suspicions, and the proper procedures for reporting incidents.

“We strongly believe that having an environment in which residents, their families, and care staff can raise concerns and file complaints about poor care or conditions benefits the entire nursing home community, including the administration and operator,” explains Mollot.

Being proactive in addressing issues gives nursing homes the opportunity to address problems before they rise to the level of a citation or result in legal action, such as if the attorney general or a resident’s family were to file a lawsuit.

There are other benefits of being proactive to take into account. “Learning about and addressing concerns fundamentally makes for happier customers, which can increase future business,” says Mollot. “This is especially true in the age of social media. Making residents feel safe and heard would undoubtedly cut down on the negative reviews we often see for nursing homes online.”

Mollot hopes that the report will encourage providers to listen more and foster better relationships with residents, their families, LTC ombudsmen, and care staff. “I also hope that it will encourage regulators and policymakers to be more cognizant of the challenges that residents face,” he says.

Creating an environment where residents feel secure reporting abuse is critical for building trust, promoting accountability, and maintaining the overall safety and well-being of senior care residents. With the insights from this new report, nursing homes and other senior care facilities can take meaningful steps to improve the quality of care in their communities.

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How Fear of Retaliation Keeps Nursing Home Residents From Reporting Abuse