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.
Full Article & Source:
How Fear of Retaliation Keeps Nursing Home Residents From Reporting Abuse
