Cedar Rapids care facility cited for untrained workers, resident abuse

By: Clark Kauffman

Heritage Specialty Care in Cedar Rapids was fined for the financial exploitation of a resident earlier this year and is now accused of using untrained caregivers. (Photo via Google Earth)

A Cedar Rapids nursing home previously fined for the financial exploitation of a resident has now been cited for using untrained caregivers.

State inspectors say the abuse involved a worker at Heritage Specialty Care who allegedly took $1,625 from a resident with a spinal cord injury. The worker then taunted the man, sending him text messages in which she called him a “vegetable” and “veggie boy.”

The inspectors also allege that Heritage, which is home to 156 older Iowans and is operated by West Des Moines’ Care Initiatives, has failed to provide its training nursing assistants, or TNAs, with either the state-approved training or the required competency evaluations.

According to inspectors, the TNAs are supposed to complete an eight-hour, online training course and then complete a skills-competency checklist through job-shadowing with a licensed worker, before working on their own.

Heritage’s nurse manager told inspectors in August that he felt an eight-hour online course was not sufficient training to perform the duties of a fully certified nurse aide and so prior to June 2020, he did not hire a single TNA to work in the home. After that, he said, the home’s owner began hiring TNAs.

One TNA at the home told inspectors the home’s training program was “not so good” and said she had worked independently at the home before completing the required competency checklist. She said it seemed to her that “everyone hired as a TNA worked with someone for four to five days and then went out on their own,” working independently, because the home was “so short-staffed.”

Another TNA agreed with that assessment and said she had refused to work on her own until completing the required skills checklist.

A third TNA confirmed the practice and said the home failed to provide adequate training to do her job. She said she had failed her community college exam to become a certified nurse aide and felt she needed more training but still worked independently in the home caring for residents.

A fourth worker told inspectors she was trained not by a certified nurse aide but by another TNA who had let her certified nurse aide’s license lapse.

That trainer told inspectors she was given no training when hired at the home and said management gave her a certified nurse aide badge and then “acted like” she was fully certified. Inspectors reported the nurse said it “made no sense” to her that she was used to train other TNAs, adding, “what else was I supposed to do” when residents needed help.

Cook tried to serve oatmeal from garbage can

Inspectors also cited the home for unsanitary practices. A cook at the home, when asked by a nurse for a bowl of oatmeal for a resident, opted not to make a fresh bowl of oatmeal and instead went to a garbage can intending to scoop out some of the discarded oatmeal that was sitting in the trash receptacle.

The nurse refused to accept the oatmeal from the trash, telling the cook, “Absolutely not.”

In addition, the home was cited for inadequate infection control. Inspectors reported that while on site, they observed a dietary aide, a certified nurse aide and an occupational therapist working with residents without the required face mask in place.

The home also was cited for insufficient staff, with one resident complaining she had to wait up to an hour to have her call light answered.

No fines were imposed by the state as a result of the inspectors’ findings in August. The home filed a plan of correction with the state that indicates it will address the citation for insufficient staff by providing “staff education.” The home has also indicated it will ensure TNAs receive the required training.

Worker allegedly took $1,625 from resident

In April 2022, the home paid a total of $650 in fines for resident abuse related to financial exploitation and for failure to conduct adequate background checks on workers.

At the time, inspectors alleged a nurse aide at the home had sold her cell phone to a resident late last year for $800 and then failed to turn over the phone. A few weeks later, when the worker was on a trip with her family, she sent a message to that same resident’s old phone, asking him to send her more money.

“Can you do $200 and I’ll pay you back when I start working more hours again,” the message read, according to inspectors who examined the resident’s phone. The resident then provided the money through an app on his phone.

The same resident told inspectors that after he loaned the worker his debit card to order him a pizza, unauthorized charges for Door Dash showed up on his bill and he had to cancel his card. In January, when the worker asked the man for another $200 and he refused, the worker sent him what the man called “mean and hateful” messages, calling him a “vegetable” and “veggie boy.”

According to inspectors, the messages, which were archived on the resident’s phone, stated: “Thanks again for saying you would help us and then go back on your own word … Have fun sitting in that s— hole with that big ego of yours.”

At one point, the worker indicated she’d soon be leaving her job at Heritage, stating, “I’m not there for the rest of my life … 11 days and I’m out sweetie … How many days ya got in heritage? Yikes, I think it’s more than 11 … But enjoy.”

When the man indicated he might report his debit card as stolen, the worker wrote back, “Good luck. LOL. I’ll tell them you let me use your card … You’ll look like a retarded vegetable lol.”

A review of transactions on resident’s cash app revealed 10 transactions, indicating the resident had transferred $1,625 to the worker.

Six other Iowa nursing homes run by Care Initiatives have been cited for major violations in recent weeks. They face fines of up to $80,250, and additional penalties may yet be imposed by the federal Centers for Medicare and Medicaid Services. The company has not responded to requests for comment.

Full Article & Source:
Cedar Rapids care facility cited for untrained workers, resident abuse

How to address the issue of resident abuse in senior living

by Jim Burke

When news broke earlier this year that a young woman, an incapacitated resident of a long-term care facility in Arizona, had given birth after allegedly being raped by her nurse, it was only the latest in a litany of abuse cases that seem to plague the long-term care industry, including senior living. At Senate hearings in March, for example, one woman testified how her elderly mother, a woman with Alzheimer’s who lived in a Minnesota memory care community, similarly had been abused by a nursing assistant.

But it’s not just sexual abuse of residents that is an issue. Here are just a few examples of other issues:

• A South Carolina-based operator of state-owned veterans’ homes is being investigated for allegations of neglect and substandard care, including failure to respond to resident-on-resident physical violence.
• Earlier this year, employees of a Columbus, OH, facility were charged with involuntary manslaughter after one resident of the home where they worked allegedly died as a direct result of their neglect (with wounds that turned gangrenous) and another suffered serious harm.
• A Jacksonville, FL-area based chain of nursing homes was sued for a stunning $350 million – an amount overturned by a judge in January – for allegedly both withholding therapy and treatments to residents as well as providing them when not needed. In one instance, a hospice resident, seeking end-of-life comfort and pain relief, allegedly was put through strenuous occupational and physical therapy. In others, residents with diabetes reportedly went without regular blood sugar tests for more than a month.

Abuse of residents of senior living communities and skilled nursing facilities is not the norm, of course, but it is a persistent and pervasive problem. Hearings such as the Senate’s one earlier this year, and others at the state level, emphasize the role of public policy and regulations in identifying and stemming abuse of residents and improving care quality.

The expectation is that once standards of care are set, employers will make every effort to attract, vet and retain staff that meets them. Meeting that expectation can be a challenge, however.

If abuse of residents is a persistent problem, then it also is an underreported one, making completely accurate data somewhat problematic. Most incidents are categorized as elder abuse, because six out of seven residents are aged 65 or more years. The majority of those who are especially at risk have dementia or moderate cognitive impairment. With communication skills and judgment impaired, they are unable to report abuse, so it continues without consequence.

In terms of the types of abuse inflicted, rape may be the most shocking type, but it’s not the most common. According to the National Center on Elder Abuse, the most common types are physical (29%) and psychological (21%) abuse, followed by gross neglect and financial exploitation (both 14%) and sexual abuse (7%). And it is not always staff members who are to blame: resident-to-resident abuse is an issue, too, representing 22% of incidents.

Fixing the problem requires approaching it from a variety of different directions. For starters, we need to raise awareness of the issue, and everyone – from family members to caregiver teams and managers – should know the signs of abuse and / or neglect. The most significant red flags:

• Physical abuse: Inadequately explained bruises, skin tears, multiple fractures or long-bone fractures.
• Sexual abuse: Bruising of the breasts, chest or genital areas; an unexplained sexually transmitted disease; bloody or purulent discharge; and undergarments that are unusually stained.
• Physical and / or medical abuse or neglect: Unintended weight loss, poor hygiene, dehydration, social withdrawal, suspicious wounds, unmonitored medications and poorly managed medical conditions.

Better, though, is to establish environments where abuse is not allowed to flourish. Not only is that the right thing to do, the stakes have gone up for facilities accepting federal dollars but failing to create safe havens with the F600 series of tags that the Centers for Medicare & Medicaid Services introduced to its survey process. The F600 tags address adherence to operating practices that are free from abuse, neglect and exploitation. They put responsibility squarely on the facility, reinforcing the importance of having an abuse policy and procedures in place that are well-communicated and strictly followed.

Regardless of where a community is located or whether a community accepts Medicare or Medicaid funding, however, several best practices are key to preventing abuse:

• Screening: Before employees or volunteers are allowed to work with residents, reference, certification and licensing verification and criminal background checks should be mandatory. Any individual found guilty of abuse, neglect or exploitation or with a disciplinary action against his or her professional license for those reasons should not be hired. Training on the abuse policy should be mandatory for new employees and volunteers before contact with residents, and so should be an all-hands attendance at periodic in-service on the policy.
• Training: A comprehensive and ongoing education program covering aspects of resident abuse, neglect and mistreatment should be mandatory for staff and volunteers. Among the topics: Ways to identify residents who are at risk, how to recognize signs of mistreatment, how to report abuse without fear of reprisal, and understanding the Resident Bill of Rights. Staff should be trained to handle and respond appropriately to difficult resident behaviors, and to recognize caregiver signs of burnout, frustration and stress.
• Prevention: The policy on prevention should cover a range of procedures, starting with a resident assessment before move-in and a regular vulnerability assessment thereafter. Other procedures should consider the community’s physical environment, population and provisions related to the risk of admitting predatory offenders, all of which are contingent on specific state and statutory requirements.
• Reporting and response:Again, specific state law and statutory requirements apply, but a two-hour window is recommended if allegations involve abuse or result in serious bodily injury. If abuse is not alleged and serious bodily injury is not involved, it should be reported within 24 hours. Reporting is made to the community’s executive director and state authorities (its survey agency, adult protective services) and law enforcement.

Communities that sharpen their focus on policies, procedures and ongoing training will create an environment where resident abuse is an unlikely risk. Ultimately, however, we need to do more, and stronger public / private partnerships may make the biggest difference in improving the care and safety of some of our society’s most vulnerable members.

David Gifford, M.D., MPH, of the American Health Care Association / National Center for Assisted Living may have put it best after testifying at the March Senate hearing: “We should expand federal programs that attract healthcare workers to the nursing home profession. We should strengthen federal regulations around reporting and sharing of information about employees who have engaged in abuse through the creation of a national background check registry. And we should make resident and family satisfaction ratings of nursing homes publicly available.

Although Gifford cited nursing homes in particular, similar actions — attracting high-quality workers, improving the reporting and sharing of information about employees who have engaged in abuse, and sharing satisfaction ratings, where available — would help senior living communities as well.

Full Article & Source:
How to address the issue of resident abuse in senior living