Federal regulators have made significant progress combating elder abuse
and financial fraud since July 2023, according to a new report.
By: Michael Adams
In recent years, the U.S. Department of Justice (DOJ) has been
working in tandem with federal, state, local and Tribal law enforcement
agencies to target financial fraud and abuse involving elderly
Americans, as well as their risks of nursing home neglect due to grossly inadequate care in long-term facilities.
Older individuals face an increased risk of falling prey to various
financial fraud schemes, and they face particular dangers of abuse at
the hands of caretakers, both at home and in nursing home facilities.
As a result of these dangers, a number of new federal programs have
been started, and legacy programs have continued gaining traction, to
help curb the physical and financial abuse of elderly Americans.
National Nursing Home Initiative Addresses Elder Neglect
The DOJ report indicates that the agency’s Elder Justice Initiative
is cooperating with 94 U.S. Attorneys’ Offices across the country to
implement the National Nursing Home Initiative, which will help identify
nursing homes that do not provide adequate staffing numbers or skill to
provide for resident care.
The National Nursing Home Initiative also tracks and identifies
nursing home facilities that do not adhere to basic nursing standards,
or provide their residents with enough food, as well as those that use
inappropriate physical and chemical restraints to sedate residents.
Government officials are already enforcing actions against nursing
home facilities that have committed fraud, provided unnecessary medical
services, or been unable to care for residents in the manner that the
law requires.
The report also indicates the DOJ’s Office for Victims of Crime (OVC)
awarded nearly $6 million to 12 different organizations that will
support local communities over a three year period, by providing
services to elderly victims of abuse and exploitation.
In addition, the agency reports that between July 2023 and March
2024, more than 9,750 individuals over the age of 60 applied for
compensation through the DOJ’s Victims of Crime Act (VOCA) Formula Grant
Program.
VOCA addresses the emotional and financial needs of crime victims, by
advocating for them and assisting with medical services, counseling,
transportation, funeral and burial costs, as well as lost work. During
the reporting period, VOCA awarded more than $79 million specifically to
organizations that assist individuals who experience elder abuse.
The DOJ has also pursued at least 300 enforcement actions against
hundreds of fraud defendants, returning more than $31 million to elderly
victims of financial scams during the covered period. In fact, the
report points out that the National Elder Fraud Hotline has fielded more
than 139,000 calls across all 50 states, as well as 44 other countries
and territories since it was launched in 2020.
“Raising public awareness is an essential part of the Department’s
efforts to combat and reduce elder abuse, neglect, financial
exploitation and fraud,” said Andy Mao, National Elder Justice
Coordinator Deputy Director of the Civil Fraud Section. “With so much
elder abuse hidden from the public eye, it is imperative that we arm our
communities with the information and red flags they need to identify
and recognize potential abuse when they see it.”
Nursing Home Abuse Affects All Americans
Nursing home neglect and elder abuse affect thousands of individuals.
However, the damage associated with these issues is not confined to the
elderly.
Recent studies have revealed that many nursing homes accused of neglect are overbilling taxpayers,
with some facilities, termed “opportunistic systems,” overcharging
Medicare by $4.3 billion. Since Medicare bills are covered by the
Centers for Medicare and Medicaid Services (CMS), which is funded by
U.S. tax dollars, these overcharges impact all American taxpayers.
You should never ignore any new physical ailments your loved one complains about.
Philadelphia, PA – Nursing homes should be a place
where the elderly or those incapacitated by disease find the care and
comfort their family is not able to provide. Under federal laws, nursing
home residents have the right to a safe environment and good medical
care. They must be free to decide about their needs or take part in the
activities they enjoy. Above all, they have the right to be shielded
against any type of abuse.
If their rights are not respected, residents or their families have only one option – find trustworthy lawyers to represent them.
Main types of abuse in Pennsylvania nursing homes
Nursing home abuse comes in many forms. It can be physical, sexual,
emotional, or financial. Neglect is also considered a form of abuse.
Although neglect is the main cause of injuries in nursing homes, that
is not the biggest problem. According to the National Center on Elder
Abuse (NCEA), emotional abuse is the most common form of abuse registered in a nursing home setting.
You may have heard horrendous reports of sexual and physical abuse
against defenseless residents, but what hurts the most is the emotional
abuse many of them experience.
Common types of emotional abuse in Philadelphia nursing homes
Nurses and aides are supposed to watch over the residents and cater
to their needs. Many spend their lives providing comfort to their
elderly charges, but there are also many who lack basic human decency.
The most common types of emotional abuse include:
Yelling at residents when they make mistakes, soil themselves, or can’t remember what they were told
Making fun of helpless residents, belittling or calling them names
Threatening residents with physical harm if they don’t obey or bother them by pressing the call button
Threatening residents with isolation from their families or other residents.
Withholding food, hydration, medications, or access to basic hygiene
Telling residents their families don’t care about them anymore.
For instance, if you’ve been trying to talk to a loved one, but the
staff repeatedly tells you they’re sleeping or having their physical
therapy session, they may be lying to you. They won’t pass along any
message just to reinforce the notion that their families have forgotten
about them. Raise your concerns with experienced Pennsylvania nursing home lawyers and they’ll advise you on the best course of action.
Signs a nursing home resident is a victim of emotional abuse
Image of an elderly woman; image
courtesy of geralt via
Pixabay, www.pixabay.com
Emotional abuse doesn’t leave visible scars. If you suspect emotional abuse, look for signs such as:
Sudden and unexplained changes in behavior
Becoming less talkative
Giving up on activities they used to enjoy
Fearfulness
Refusal to talk about their daily routine or being very vague about their life
Submissive behavior when members of the staff are around
Emotional abuse can be hard to prove, so seek legal counsel from good nursing home abuse lawyers in your area.
You should never ignore any new physical ailments your loved one
complains about. Lack of adequate medication, food, and hydration can
cause serious health problems. You should reach out to reputable medical malpractice lawyers.
They will need your approval to examine the resident’s medical records
to understand what’s going on before you can file a lawsuit.
Seniors in nursing homes are entitled to be cared for appropriately
by staff members of their care facility. If a caregiver intentionally or
negligently harms them, a nursing home abuse lawsuit helps affected
seniors or their family members obtain the compensation they deserve.
Despite legislation mandating the quality of care nursing homes must
provide and periodic inspections by state agencies to ensure compliance,
nursing home abuse continues to be a significant problem in many of the
nation’s nursing homes.
This guide helps you understand when you are able to file a nursing
home abuse lawsuit, who can be held accountable for the abuse and what
types of compensation should be available for losses.
What Is Nursing Home Abuse?
Nursing home abuse occurs whenever a caretaker in
a care facility provides inappropriate care. The abuse could be
intentional, such as hitting or kicking a senior nursing home resident.
Or it could occur as a result of a negligent failure to meet the needs
of seniors for whom caregivers have responsibility.
When nursing home abuse occurs, victims or their families have legal
rights. A nursing home abuse lawsuit helps those affected by wrongdoing
to be “made whole” or recover the compensation they deserve for the
damages endured as a result of unlawful abuse or neglect.
How Common Is Nursing Home Abuse?
Nursing home abuse is, tragically, very common in
large part due to understaffing, low pay and inadequate training of
staff members. Sometimes, it also occurs because care facilities do not
properly screened staff before hiring them.
The World Health Organization (WHO)
reports that around one out of six seniors 60 or older endure some type
of abusive behavior in a community care setting over the course of each
year. Sadly, the WHO also indicates that as many as two in three staff
members in nursing homes admitted to committing abusive acts over the
course of the past 12 months.
What is even more disturbing than the reported frequency of nursing
home abuse is that abuse may be occurring and not get reported. A 2017
study by the Office of the Inspector General (OIG)
reviewed the emergency room records of 134 Medicare recipients in
skilled nursing care facilities whose injuries may have been the result
of abuse or neglect. In 28% of the cases, there was no evidence that the
incidents leading to emergency room visits were ever reported to law
enforcement.
These shocking statistics show that anyone could become a victim of
abuse. Those with loved ones in nursing homes must be vigilant about
watching for and responding to signs that something is wrong.
Types of Nursing Home Abuse
Nursing home abuse can take many forms, but there
are several common categories that abusive behavior tends to fall into.
They include physical abuse, financial abuse, sexual abuse, emotional
abuse and neglect.
Physical Abuse
Physical abuse in a nursing home setting occurs when a caregiver causes intentional harm. This could involve:
Hitting
Pushing
Kicking
Burning
Financial Abuse
Financial abuse happens when a caregiver manipulates a senior into
giving away money or valuable possessions or when a caregiver takes
money or possessions from a resident without authorization or approval.
Sexual Abuse
Sexual abuse involves any unwanted sexual activity with nursing home
residents who do not give consent or who cannot give consent due to
mental incapacity.
Mental/Emotional Abuse
Emotional and mental abuse is harder to identify because it can
involve insulting or demeaning comments, threats, withholding of
entitlements and other types of abusive behavior that do not result in
observable damage. Name calling or derogatory statements such as
suggesting family members don’t love them and won’t be visiting them are
other examples of emotional abuse.
Neglect
Finally, neglect involves failing to provide a reasonable level of
care for nursing home residents. It is mistreatment without physical
force and occurs when nursing home caregivers do not meet a resident’s
basic care needs. This includes failing to administer required
medications or not moving patients often enough, resulting in the
development of bedsores.
Warning Signs of Nursing Home Abuse
Unfortunately, nursing home residents are often
unable to speak up about their own abuse. This could be because they are
afraid of repercussions or have no one to tell about what they are
experiencing. Sometimes, medical conditions such as dementia can also
make it difficult for seniors to speak up about what is happening to
them.
Family members and other visitors should make sure to watch for
warning signs of abuse so they can step in if something is wrong. Some
common warning signs of abuse include:
Bone fractures
Burns
Bruises
Welts
Bedsores
Cuts
Dehydration
Malnutrition
Facial injuries
Sepsis
Sexually transmitted diseases
Unexplained weight loss
Changes in behavior such as no longer participating in activities
Changes in attitude such as depression or being withdrawn
Dirty sheets, clothing or floors
Abuse can cause serious mental and emotional damage to vulnerable adults. It can sometimes result in death.
Anyone who suspects nursing home abuse should report it promptly to
the appropriate authorities and consider speaking with an experienced
attorney about how to help victims pursue a claim for compensation for
losses resulting from the wrongful behavior.
Legal Rights of Nursing Home Residents
Nursing homes that receive Medicare or Medicaid
payments must comply with federal requirements for resident care. There
are over 15,500 nursing homes certified to receive Medicare or Medicaid
in the United States, housing more than 1.4 million residents.
In 1987, federal law established a nursing home resident bill of
rights as part of a sweeping reform package aimed at improving the
quality of care received by nursing home residents in the United States.
The Nursing Home Reform Act
grants nursing home residents legally enforceable rights establishing a
minimum standard of care. Individual states may have added additional
requirements to the federal standard.
The federal Nursing Home Bill of Rights states that nursing home residents are entitled to:
Freedom from abuse, mistreatment and neglect
Freedom from physical restraints
Accommodation of medical, physical, psychological and social needs
Be treated with dignity
Privacy
Make their own decisions
Communicate freely
Voice grievances without retaliation
Who Can File a Nursing Home Abuse Lawsuit?
Nursing home abuse is unlawful. Those who engage
in abusive behavior can face criminal charges. A nursing home abuse
lawsuit can also be filed by victims. This is a civil lawsuit, which is
separate from a criminal case. The purpose of a civil claim is for
victims to be “made whole” for damages they endure. They are entitled to
be compensated financially for economic and non-financial losses.
Seniors who have been victimized by abusive or neglectful behavior
can file a nursing home abuse lawsuit to recover the monetary damages
due to them. If seniors are mentally incapacitated, their representative
can file a lawsuit on their behalf.
If the abuse results in wrongful death, the senior’s estate or close surviving family members can pursue a wrongful death claim.
There are two legal bases for imposing liability that nursing home abuse lawsuits may use to support a civil cause of action.
Breach of Contract – A nursing home and a resident
have an agreement where the nursing home agrees to provide a certain
level of care in exchange for a fee. When the nursing home does not
provide the agreed-upon level of care, a resident may have the right to
sue for the failure of the nursing home to do what was promised.
Violation of Law – Nursing homes must comply with
both federal and state laws establishing minimum standards of resident
care. Failing to meet the minimum care standard gives nursing home
residents the right to sue the facility for any damage caused.
Who Can Be Held Responsible for Nursing Home Abuse?
In many cases, a nursing home lawsuit will be
filed against the nursing home that employs the abuser. Nursing homes
have insurance and have deeper pockets so are more likely to be able to
pay out the compensation for damages.
A nursing home can be held accountable for abuse that staff members commit under a legal doctrine called vicarious liability.
Vicarious liability rules make employers responsible for wrongful or
negligent acts that workers commit in the course of performing their
work duties. This is true regardless of whether the nursing home owners
themselves were negligent.
A nursing home can also be held accountable for its own negligence.
For example, if the facility was understaffed or staff members were
inadequately trained, this provides the grounds for a nursing home abuse
lawsuit.
Proving Nursing Home Abuse
Proving nursing home abuse can be difficult
because residents may injure themselves or may not be able to
communicate exactly what happened and how. Supporting documentation such
as medical records, previous complaints, photographs, communications
from a resident and noted observations can help prove the mistreatment
of a nursing home resident.
One source that can both help prove abuse and prevent it is the use
of surveillance cameras in the rooms of nursing home residents. Only a
small but growing percentage of US states have laws specifically
authorizing nursing home residents to install surveillance cameras in
their rooms. The laws must balance the privacy concerns of residents
with the desire to monitor the activities within a resident’s living
space.
California does not currently have any law giving nursing home
residents the right to install surveillance cameras in private areas.
But the state’s Department of Social Services has issued guidelines for individual care facilities
that choose to install surveillance equipment in the rooms of
residents. Surveillance equipment and the recorded footage are legal as
long as the guidelines are followed.
In Texas, nursing home residents have the right to install
surveillance equipment in their rooms. Each resident must pay for
everything but the nursing home is required to make reasonable
accommodations to enable the installation.
Statute of Limitations for a Nursing Home Abuse Lawsuit
Nursing home abuse lawsuits are personal injury
claims, and state statute of limitations apply to these types of cases.
An abuse lawsuit must be filed within the statute of limitations or the
claim will be time barred and unable to be brought forward.
The time limit for making a claim varies by state but is usually
between two years and four years from the time the abuse occurred or
from the time the abuse was discovered or should have been discovered.
It is important to file a nursing home abuse lawsuit in a timely
manner when abuse or neglect occurs. The sooner a claim is filed, the
easier it is to obtain the necessary evidence of wrongdoing and to get
statements from witnesses who may be nearing the end of their lives.
However, it’s also important to ensure the full extent of the abuse and
resulting injuries are apparent before a claim is resolved.
A nursing home abuse lawyer can help victims and their loved ones to
gather evidence and move forward at an appropriate time in pursuing a
claim for damages.
Compensation for Nursing Home Abuse
If a nursing home abuse lawsuit is successful, the victim could recover compensation for:
Medical bills
Loss of money or income, if applicable
Pain and suffering the victim experiences as a result of the abuse
Emotional distress resulting from the abusive behavior
If the abuse resulted in a fatality, surviving family members or the
estate of the deceased senior can bring a wrongful death claim. This
could result in compensation for medical bills incurred before death,
pain and suffering, financial losses, emotional distress and lost
companionship of the victim.
An elder abuse lawyer can provide help in filing a nursing home abuse
lawsuit, gathering evidence and showing the extent of damages in order
to maximize financial recovery in these troubling cases.
After a the New York Attorney General filed a lawsuit
in December against a Long Island elderly care facility, nursing home
abuse has once again taken the national news spotlight.
Milwaukee, WI (PRUnderground) January 5th, 2023
This
time around, a New York facility under fire is accused of keeping its
residents in unacceptable living conditions while the company’s owners
fraudulently diverted millions of dollars to their own pockets.
Personal injury attorney Robert Welcenbach of Welcenbach Injury Law in Milwaukee, Wisconsin, says action is needed in order to hold facilities accountable for their actions and prevent further injury to elderly residents.
Following a particularly terrible incident in a Wisconsin nursing home
earlier this year, instances of flagrant neglect and abuse are piling
up in facilities that are supposed to provide premium care for some of
society’s most vulnerable people.
“Pursuing legal action is crucial,” Welcenbach said. “Not only do
mistreated residents and their families deserve justice and
compensation, but these lawsuits are needed in order to put nursing
homes on notice.”
Welcenbach believes one of the best things families of nursing home
residents can do is watch for the tell-tale signs of elder abuse and
neglect. This enables family members to advocate for their elderly
relatives’ rights. It also allows them to collect proof of wrongdoing on
the part of the facility staff.
Nursing Home Abuse and Neglect: A Growing Problem
Since elderly residents of nursing homes often already suffer from
declining health—both physically and mentally—family members often
struggle to identify and address signs of neglect and abuse in the
facility.
“You want to be able to put your trust in the staff,” Welcenbach
explained. “After all, they’re professionals, and you’ve spent a lot of
money to have your loved one cared for.”
However, there are thousands of nursing home abuse, and neglect cases
reported every year, and millions are affected by elder abuse in
general.
These cases often involve physical, sexual, or psychological
abuse—whether at the hands of a staff member, family member, or fellow
resident—but they can also involve harmful acts of neglect and financial
exploitation.
Possible Damages in Nursing Home Neglect and Abuse Lawsuits
Welcenbach explained that the damages victims and families experience
in nursing home abuse cases can vary widely and include all kinds of
loss.
While there are financial costs associated with the increase in
medical care and treatments after instances of prolonged neglect or
abuse, that’s not the only damage these families suffer.
“The psychological toll that abuse has on an individual is
significant,” Welcenbach noted. “Then, you add to it the emotional
distress that their family members experience afterwards. The
responsible parties need to be held liable for this kind of devastating
loss.”
Each year, nursing home
abuse leaves many seniors physically harmed, financially ruined, and
emotionally traumatized. Often, the culprits are the staff members or
the residents tasked to keep them healthy and happy.
To
protect your loved ones in nursing homes, you must regularly check on
them and report any warning signs of abuse. It is also essential to seek
the help of competent personal injury attorneys once you have solid proof of abuse.
Nursing Home Abuse
Any form of harm that is inflicted on
elderly residents in long-term care facilities, including sexual
assault, financial exploitation, and physical or emotional abuse is
commonly referred to as nursing home abuse.
Unfortunately, an
elderly loved one may not even realize they are being neglected or
abused, and they can take action and assert their legal rights. Often,
adult family members will take on the task.
What You Need to Know When Getting Help
If you are taking steps to protect your
loved one, it is ideal that you know what to expect when working with a
personal injury attorney. Below are some of the possible steps you and
your chosen lawyer will undertake.
Investigate the claims
In many cases, the nursing home and the
insurance company might deny their staff or any of their employees did
anything wrong. This means you need to prove their liability so you can
obtain the compensation your loved one deserves.
Your lawyer will also gather the needed evidence to start building the case. This process can include:
Interviewing witnesses
Your lawyer will interview the victim of
the neglect or abuse to gather information needed for the case. Friends
or family members who have witnessed the abuse or have observed
physical or psychological changes will also be interviewed.
Interviewing former employees
Former employees who witnessed the abuse
inflicted upon your loved ones can provide a wealth of information that
can help the case. Aside from that, they might also provide information
about how residents are treated or the standard practices in the
nursing home.
Reviewing records
Your lawyer will most likely request a
copy of the inspections or survey reports that may provide evidence of
violations of state or federal regulations regarding resident care.
Reports of any abuse by physicians or nurses may also be considered to
determine if they did not provide the standard of care that applies to
the victim's situation.
Your lawyer might also look for valuable
information on the procedural manuals that pertain to the care of
nursing home residents.
Checking medical and other records
Depending on the type of neglect and
abuse, your lawyer might also obtain the victim's medical record to
prove if there were medical errors made. Most likely, your lawyer will
also check if medical conditions were left untreated or sufficient
nutrition or hydration was not provided.
If other forms of abuse
are suspected, your lawyer might request additional documents such as
financial records to see if any money was stolen from your loved one.
Negotiating with the Nursing Home
Once your attorney has completed the
initial investigation, he will assist in filing an administrative case
against the nursing home. Most likely, he'll also send a demand letter
outlining the neglect or abuse your loved one experienced.
Your
lawyer may also enter into negotiations with the nursing home and the
insurance company. Whether the claim is settled or not will depend on
many factors, including the evidence the lawyer uncovered, the insurance
adjuster's willingness to settle the claim, and how strong the case is
against the nursing home.
Conclusion
Suppose the statute of limitations
is about to expire, or the settlement negotiations are not productive,
your lawyer will likely file a lawsuit against the liable staff members
and the nursing home.
During the litigation process, your lawyer
will continue to collect evidence, prepare for trial, and attempt to
settle the case when he believes negotiations are more fruitful.
Steve Piskor placed a camera in his mother’s room at a Cleveland nursing home in 2011.
From the camera’s recordings, Piskor discovered eight aides abusing his then-78-year-old mother, Esther, who had Alzheimer’s disease and died in 2018.
Eventually, two of the aides went to prison, three were fired and three were disciplined, Piskor said.
The family’s experience with elder abuse inspired Senate Bill 255 and House Bill 461,
or “Esther’s Law,” companion measures introduced in the Ohio
legislature in December. It would allow residents of facilities like
nursing homes and assisted living facilities to set up a video recording
device in their room.
“I’m not trying to say all aides are bad
and all nursing homes are bad. ... What we’re trying to do is just stop
the abuse,” said Piskor, 65, of Cleveland.
Piskor shared his
experience during the second meeting of the Summit County Nursing Homes
and Facilities Task Force on Tuesday morning in the Greater Akron
Chamber office.
The group is focusing on three areas: reviewing
current conditions, assessing possible solutions and best practices, and
making recommendations. The group will then present its findings and
recommendations to Summit County Council and the county executive in a
written report this year.
At its first meeting in November,
four committees were created: legislation, operations, visitation of
facilities and staffing, with each committee giving an update Tuesday.
One
of the primary focuses of the task force is staffing issues. Wayside
Farm Nursing & Rehabilitation Center administrator and task force
member Matthew Pool called staff retention and recruitment a “top
priority.”
“Without staff, we’re not going to have the quality of care that we’re looking for,” he said.
Preliminary
ideas from the task force include a workforce development initiative
with Stark State College and a Peace Corps-style training program within
the county for young people interested in health care or caregiving.
The program would allow them to get experience in nursing homes and
other facilities and potentially be hired permanently in the future.
“We’ve been hearing this ever since we mentioned we were looking into
this, not only from the providers of the service but from families who
have loved ones in the facilities,” Summit County Council President Jeff
Wilhite said of staffing issues.
He
also noted the impediments that can keep people from getting to work,
like transportation or day care for their children, and said the task
force could help look for solutions to those issues.
Summit County
Executive’s Office senior administrator and task force member Whitney
Spencer proposed working with Akron Public Schools, which offers health
care-related pathways through its College and Career Academies, on the
staffing issues affecting nursing homes and other facilities.
Kim
Hone McMahan, a retired Beacon Journal reporter and columnist whose
103-year-old mother was injured in a nursing home in May, said staff at
nursing homes and other facilities are often underpaid, under-trained
and difficult to retain, saying she’s found some facilities with a
turnover rate of 100%.
“Many if not most incidents in nursing homes are [due to] a
lack of staffing, proper staffing,” said McMahan, saying the lack of
proper staffing “has reached a crisis.”
Future
task force meetings are scheduled for Feb. 18, March 24, April 21 and
May 19, all at 10 a.m. in the Greater Akron Chamber conference room in
Akron’s AES Building, 388 S. Main St., Suite 205. The meetings are open
to the public.
For questions, call the Summit County Council office at 330-643-2725.
CHERRYVILLE,
N.C. (WBTV) – Late this past summer, Renee Herwin had suspicions about
the care her 86-year-old mother, Skip MacNally, was getting at the Peak
Resources nursing home in Cherryville, N.C. So, she decided to install a
hidden camera to find out.
Herwin
bought a picture frame with a tiny camera hidden at the bottom. She put
it on a counter top in her mom’s room. She had disturbing video of
staff at the nursing home abusing her mother almost immediately.
“I
put the camera in on August 28. On August 29 I had a video of abuse,”
she said. She had a second video within 24 hours of installing the
camera.
The
first video shows a nursing assistant yelling at MacNally—who is blind
and suffers from alzheimer’s disease—while changing her. In the video,
you see the nursing assistant go from yelling at MacNally to violently
moving her across the bed while changing her. MacNally cries out in pain
several times over the course of the video.
“Have I done something?” MacNally asks the nursing assistant towards the end of the video.
“Devil’s wife,” the nursing assistant responds.
Herwin
expected the hidden camera to capture evidence of her mother not being
properly fed or going long periods of time without being checked on. She
didn’t expect to find her mom being violently abused by staff.
“I
was livid,” Herwin said of the first time she saw the video. “It was,
‘oh my God, I can’t believe –‘ this was the last thing I expected.”
Herwin
took the video to the nursing home’s director, who fired the two
employees captured in the two videos and called DSS and police.
In
a statement, the nursing home administrator, Kris Thompson, confirmed
the incident but said he could not discuss the matter further due to
federal privacy laws.
“The
mission and main priority of our facility is the safety and well-being
of our residents, and we endeavor to respond accordingly to anything
that might negatively impact any resident,” Thompson said. “Our top
priority, as always, is to remain committed to our residents and their
families and we will continue to do so in this situation.”
A
DSS report shows a social worker confirmed MacNally was abused but
indicates the social worker didn’t open an investigation because, the
form says, the two employees were fired.
Herwin said police also investigated and a detective called her to say he wanted to press charges.
“Well,
he called me about four days later, told me the (assistant district
attorney) was not going to file charges. I didn’t understand,” Herwin
said.
To date, no charges have been filed against the employees in the video.
Gaston
County District Attorney Locke Bell did not respond to multiple
messages seeking an explanation as to why he would not file charges for
elder abuse, which is a crime under North Carolina law.
Herwin said she met with Bell but didn’t walk away from that meeting with any better understanding as to why he wouldn’t act.
“I
told him that, based on the way the law is now, if a background check
was run on this CNA, there would be nothing to alert them that there
were abuse confirmations. That’s as far as I got with him and he blurted
out, ‘You want me to destroy this woman’s life!’” Herwinn recalled of
her meeting with Bell.
Herwin said Bell watched the video, told her he didn’t see anything criminal in the video and ended the meeting.
“That’s all he said,” Herwin recalled. “No explanation. Nothing.”
Herwin
called WBTV in hopes the story of what happened to her mother would
draw attention to a system that has lax regulation and little oversight.
Because
charges weren’t pressed against either nursing assistant, Herwin fears
no future employer will ever know what they did to her mother.
“They
need to have consequences for their actions! If you don’t have any
consequences, it’s just going to continue to get worse,” she said.
SHEBOYGAN - A Green Bay man was charged
Monday with four felonies related to two July 7 incidents in which a
coworker said he assaulted a resident in the Sheboygan nursing home
where he worked.
David Stephen
Boozer, 66, was charged with two counts of intentionally subjecting an
individual at risk to abuse and two counts of aggravated battery to the
elderly.
According to court documents, a coworker
assigned to a floor for patients with dementia and Alzheimer's said she
saw Boozer use violence to get a patient back to his room, including
punching the patient in the chest. After Boozer pushed the patient back
to his room in a wheelchair, she found the patient on the floor and the
wheelchair tipped over, she told police.
David Stephen Boozer (Photo: Sheboygan County
Sheriff's Department)
A little while later, the coworker said Boozer rammed a
wheelchair into the same patient's legs. When the patient tried to
enter another patient's room, Boozer dragged him to the floor and out of
the room by the shirt, court documents said.
According
to court documents, the coworker estimated that she had worked with
Boozer about 20 times in the past. She previously reported him to the
nursing home's administration for negligence, she told police, including
for one instance where she said he refused to provide needed
medications to dying patients.
A cash bond of $50,000 was set and a preliminary hearing is scheduled for July 17.
But
if your older adult can’t remember how they broke their hip, hit their
head, or suffered an injury, you might wonder if it was truly an
accident or if nursing home abuse was involved.
If
a nursing home failed to properly care for your older adult, you may be
able to file a lawsuit to cover your parent’s medical costs and receive
compensation for their pain and suffering.
If it’s determined that your older adult was abused, an attorney can help you report it to the proper authorities and make sure their rights are protected.
Use
these tips to find out how the injury happened, identify signs of elder
abuse, how to know if the nursing home was at fault, and what to do if
nursing home abuse is a real possibility.
5 steps to find out how the injury happened
If
your older adult can’t recall how an injury occurred, you may need to
investigate on your own. Here are 5 steps that help you find out what
happened.
1. Ask around Ask other residents if they saw anything, especially if your parent has a roommate.
2. Request a care plan meeting Meet with the Administrator and Director of Nursing to bring attention to the situation and determine how it occurred.
3. Contact the local ombudsman If you’re not getting appropriate answers, report the incident to your state’s elder abuse ombudsman or the state agency that regulates nursing homes or assisted living communities.
4. Check for security footage If the accident took place in a common area, a security camera may have captured it.
Note that private facilities aren’t legally obligated to share footage unless required by local authorities or a court order.
5. Have a doctor examine them Your
older adult’s physician can also do a physical exam to help identify
possible causes of the injury and whether it seems to have been caused
by abuse or if it was more likely an accident.
Look for common signs of elder abuse
If this isn’t the first unexplained injury your older adult has suffered, don’t rule out the possibility of elder abuse.
Unusual injuries
– If bruises are large or in odd places like on the face, neck, upper
back, or chest, investigate further. Also look out for burns or
indications of physical restraint.
Severe injuries – A serious injury, like a broken bone, without an explanation of how it happened could be a sign that something is wrong.
Malnutrition
– Sudden weight loss, dehydration, or bowel impaction (often caused by
dehydration or insufficient fiber), could mean that your parent is
malnourished.
Unsanitary conditions
– Soiled clothing, dirty linens, or evidence that your older adult is
being forced to lie in bodily waste are also clear signs of abuse.
Additional signs of elder abuse include:
Sudden changes in personality and behavior, including depression and withdrawal.
Your older adult becoming quiet when a certain staff member is present.
Your older adult refusing to see a doctor or dismissing the severity of their injury.
Caregivers not wanting you to be alone with your older adult.
Caregivers offering differing explanations or unusual excuses for the injuries.
How to determine if the nursing home is at fault
Whether
your older adult was hurt in an accident or abused by a caregiver, the
nursing home or assisted living community could be at fault for their
injuries.
3 top factors that could make the nursing home liable are:
1. Negligent staffing The
care community could be liable if they are understaffed, have
unqualified people on staff, don’t provide adequate training, or if they
hire people who have a history of abuse.
2. Inadequate security A
care community could be liable if they fail to install locks and alarms
to keep patients from wandering inside the facility or leaving the
building.
They could also be at fault if there are a lack of security cameras that could help prevent violence or abuse from occurring.
3. A hazardous environment If
the care community has failed to address tripping hazards like slippery
floors or raised carpeting, they could be at fault for an injury caused
by these hazards.
6 steps to take if you suspect nursing home abuse
1. Talk with other families Ask other families they’ve noticed similar injuries on their older adults or rough behavior by any staff members.
2. Report your concerns File a formal complaint with the Administrator and/or the Director of Nursing.
3. Install a camera in their room Installing a camera means that you can observe and record what happens in your older adult’s room. Be
sure to research the privacy laws in your area – you may need to put a
notice on the door alerting others of the camera’s presence.
Note:
Some states, including Illinois, Maryland, New Mexico, Oklahoma, and
Texas, do allow cameras to be installed in private nursing homes.
4. Visit regularly Do
your best to visit your older adult weekly, or even multiple times a
week. The age-old saying “the squeaky wheel gets the grease” helps your
older adult get better care.
You
want the care community’s staff to get to know you and, more
importantly, to know that you care about your older adult and you’re
keeping an eye on them.
6. Document everything and report it to the proper authorities Having a record of what happened is important when reporting the incident to local authorities. These could include the police, Adult Protective Services, or an ombudsman program in your area to advocate on your older adult’s behalf.
"It was devastating,” he said. “Even to this day, my family can't look at the video."
Seeing his frail mother’s body flung into bed. Her face poked with a disrespecting finger.
Assaulted by health professionals Piskor trusted. “Every time I look at them, I get more mad,” he said.
“Them” represent the video images Piskor captured in 2011, when he
placed a hidden camera in his mother’s room inside a nursing home run by
MetroHealth Medical Center.
He placed them there on a hunch. The unexplained bruises. Her quiet moods.
“I
began seeing changes in my mom,” he recalled. “By then, I knew
something was happening…When I put the camera on, I found abuse in the
first two days. But I didn’t know how it was going to be handled.”
The
video sent shockwaves through the community. Two aides were indicted
and later jailed. Three were fired, and three others were disciplined.
But then, nothing.
His
mother, Esther “Mitzi” Piskor, died last year at the age of 85. Her son
is intent on ensuring her legacy lives on, and that the trauma she
endured is not forgotten, or allowed to be repeated.
"Yes, I definitely think it's time to pass the law."
He’s
talking about “Esther’s Law,” a proposal in the process of being
crafted into a bill by state Sen. Nickie Antonio, D-Lakewood. While no
formal bill has yet been crafted, Antontio says the heart of the
proposal would allow families to place a camera in a loved one’s nursing
home room.
"Anybody's that's walked the path with their own
parents as they age understand the need for special protection as people
get older," Antonio said. “Not only is it important today, it's going
to be important tomorrow.”
Ten states now have laws dealing with
cameras. Antonio believes Ohio should be modeled after the law recently
enacted in Illinois.
It would require that cameras not be hidden. A
sign would be posted outside the room alerting everyone that a camera
is in use. A consent form would allow for the cameras to be turned off
for various reasons, such as bathing or visits from doctors or clergy.
There are also provisions on roommates and their privacy.
“We
want them to age with dignity, want them to be taken care of safely and
appropriately and I think this will help,” Antonio said.
A similar effort in 2013 never gained enough support and the legislation fizzled.
The
Ohio Health Care Association, an association of nursing homes and
assisted living facilities in the state, raised some concerns on how the
placement of cameras would blend with existing privacy laws. A
spokesman told Channel 3 News that those same concerns should be
addressed in any new proposal.
To Steve Piskor, he’s aware of
privacy concerns and he believes that the success of similar laws in
other states is proof tjhat “Esther’s Law” is viable. And necessary,
especially as Ohio’s population continues to grow older.
He said he wants “Esther’s Law” to be a symbol for change.
"Because
every time that camera goes into a nursing home, that nursing home is
going to know that it was...because they abused my mother.”
"Esther's Law" would allow Ohio families to place cameras in nursing home rooms.
Author:
Phil Trexler
CLEVELAND — The images still anger Steven Piskor.
Even eight years later.
She was his mother, after all.
"It was devastating,” he said. “Even to this day, my family can't look at the video."
Seeing his frail mother’s body flung into bed. Her face poked with a disrespecting finger.
Assaulted by health professionals Piskor trusted. “Every time I look at them, I get more mad,” he said.
“Them” represent the video images Piskor captured in 2011, when he
placed a hidden camera in his mother’s room inside a nursing home run by
MetroHealth Medical Center.
He placed them there on a hunch. The unexplained bruises. Her quiet moods.
“I
began seeing changes in my mom,” he recalled. “By then, I knew
something was happening…When I put the camera on, I found abuse in the
first two days. But I didn’t know how it was going to be handled.”
The
video sent shockwaves through the community. Two aides were indicted
and later jailed. Three were fired, and three others were disciplined.
But then, nothing.
His
mother, Esther “Mitzi” Piskor, died last year at the age of 85. Her son
is intent on ensuring her legacy lives on, and that the trauma she
endured is not forgotten, or allowed to be repeated.
"Yes, I definitely think it's time to pass the law."
He’s
talking about “Esther’s Law,” a proposal in the process of being
crafted into a bill by state Sen. Nickie Antonio, D-Lakewood. While no
formal bill has yet been crafted, Antontio says the heart of the
proposal would allow families to place a camera in a loved one’s nursing
home room.
"Anybody's that's walked the path with their own
parents as they age understand the need for special protection as people
get older," Antonio said. “Not only is it important today, it's going
to be important tomorrow.”
Ten states now have laws dealing with
cameras. Antonio believes Ohio should be modeled after the law recently
enacted in Illinois.
It would require that cameras not be hidden. A
sign would be posted outside the room alerting everyone that a camera
is in use. A consent form would allow for the cameras to be turned off
for various reasons, such as bathing or visits from doctors or clergy.
There are also provisions on roommates and their privacy.
“We
want them to age with dignity, want them to be taken care of safely and
appropriately and I think this will help,” Antonio said.
A similar effort in 2013 never gained enough support and the legislation fizzled.
The
Ohio Health Care Association, an association of nursing homes and
assisted living facilities in the state, raised some concerns on how the
placement of cameras would blend with existing privacy laws. A
spokesman told Channel 3 News that those same concerns should be
addressed in any new proposal.
To Steve Piskor, he’s aware of
privacy concerns and he believes that the success of similar laws in
other states is proof tjhat “Esther’s Law” is viable. And necessary,
especially as Ohio’s population continues to grow older.
He said he wants “Esther’s Law” to be a symbol for change.
"Because
every time that camera goes into a nursing home, that nursing home is
going to know that it was...because they abused my mother.”
When it comes to abuse, most
people think about it in terms of domestic violence or child abuse. But
when you look at the data, it becomes clear that one massive population
is being overlooked: the elderly.
Understanding the Nursing Home Abuse Crisis
Nursing home abuse is a catchall term
used to describe any situation in which a responsible individual takes
advantage of an elderly resident. It can include physical abuse, sexual
abuse, emotional abuse, confinement, passive neglect, willful
deprivation, and financial exploitation.
According to the National Council on Aging,
1 in 10 Americans over the age of 60 have experienced some form of
elder abuse. And despite the fact that 5 million elderly individuals are
abused annually, just 1 in 14 cases (7 percent) are ever reported to
authorities.
When it comes to high-risk settings,
nursing homes come in at or near the top of the list. Residents can be
isolated and typically don’t interact with friends and loved ones on a
daily basis. This makes them more vulnerable to abuse.
5 Ways to Prevent Nursing Home Abuse
Whether you’re an elderly individual
or have a family member who is, it’s important that you educate yourself
on this issue. Collectively, we can work together to propose and
implement effective solutions.
Greater Awareness
The solution starts with increased
awareness. The majority of people – including those who have loved ones
in nursing home facilities – have no idea that abuse is a prevalent
issue. Conspicuous ad campaigns and more features stories like these will make people aware of what’s really happening behind closed doors.
Better Vetting and Staffing
Nursing home abuse doesn’t always
have premeditated malintent behind it. In a large percentage of cases,
it stems from overworked employees who are exhausted and
under-resourced.
“While there is nothing illegal about
making a profit by caring for people, a conflict arises when operators
attempt to maximize profits byreducing the staffing levelsand hiring inexperienced workers,” Rosenfeld Injury Lawyers explains. “These cost-cutting measures impact patient care, often causing serious injuries and deaths.”
Nursing homes should do a better job
of vetting potential hires and using strategic approaches to staffing to
ensure that employees don’t burn out. It’s also important to set and
maintain reasonable staff-to-resident ratios that ensure each individual
has the opportunity to be cared for. Cost cutting should never
compromise the quality of care.
More Oversight
We need more oversight over nursing
homes to ensure they aren’t engaging in reckless behavior. The Centers
for Medicare & Medicaid Services (CMS) seems to be taking the lead
on this.
As CMS explains,
“America deserves nursing homes that ensure residents are treated with
dignity and kept safe from abuse and neglect; that are rewarded for
value and quality; whose patient outcomes are transparent to consumers;
all without unnecessary paperwork that keeps providers from focusing on
patients.”
As of Spring 2019, CMS has started
the process of conducting a comprehensive review of regulations,
guidelines, processes, and internal structure as it relates to the
safety and quality of nursing homes. The hope is that this review will
lead to more oversight from the appropriate governing bodies.
Greater Accountability
In addition to more oversight,
individual nursing homes need greater accountability. And who better to
supply this accountability than the residents themselves?
Every nursing home should have a
committee that consists of both residents and administrators. This
committee should regularly convene and discuss the concerns of the
residents, as well as the priorities of the facility. The hope is that
common ground goals can be achieved without compromising the quality of
resident care.
More Loved One Involvement
Loved ones are a key piece to this
puzzle. The more they’re involved with the residents, the less likely
that abuse will be allowed to thrive. In addition to phone calls, family
members should make it a priority to regularly visit residents to check
in and spend quality time together.
Adding it All Up
The prevalence of nursing home abuse
in America – and around the world, for that matter – is unacceptable.
Most victims are unable to properly protect themselves and/or speak out.
Thus, the onus falls on family members, nursing home administrators,
law enforcement, and government leaders to step up and implement
positive changes.
Abuse complaints in nursing homes are rising.Pixabay | File photo
By Ted Sherman
(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.”
An
examination of state and federal nursing home inspection reports since
2016 turned up few cases classified by investigators as significant
threats to residents.
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.”
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.
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.
