Article Page Three: Besides Lack of
Prosecution, Elderly Abuse
Often Not Reported by Bryan Robinson - 7 March, 2001
'He Started Beating Me ...'
Helen Love, a 75-year-old grandmother of three, looked into the
video camera and told of being severely beaten by a nursing home caregiver who
discovered she had soiled herself. "He choked me and he went and broke my neck," said Love,
who had to wear a metal halo in the videotaped deposition from July 1998.
"He broke my wrist bones, in my hand. He put his hand over my mouth."
Two days later, Love died.
Nursing home
officials did not report her beating to a state official who was at the nursing
home at the time. Ultimately, though, Love's attacker served a year in prison.
An investigation revealed that he had been fired by two previous nursing homes
for aggressive behavior.
On Monday, the Senate Select Committee on Aging saw Love's deposition and got
the results of a General Accounting Office report on elder abuse. An 18-month
review of three states with high nursing home populations suggested that cases
like Love's may be more common. The report found that many nursing home abuse
cases are not immediately reported to law enforcement officials.
Anatomy of Abuse Neglect
The GAO report
found that 50 percent of abuse reports from nursing homes came at least two or
more days after caregivers first learned about allegations. The delay hampered
gathering evidence and made prosecuting the cases difficult.
But some experts suggest the problem could be worse.
"The biggest problem is that these people are hidden. There is very little
traffic going into these [nursing] homes from relatives of these victims or
people who could observe what's going on," said Sara Aravanis, director of
the National Center on Elder Abuse.
A 1996 report by the National Center on Elder Abuse estimated that unreported
cases of elder abuse outnumber reported cases by a ratio of 5-to-1. According to
the Senate Special Committee on Aging, which held a hearing into the issue
Monday, more nursing homes are being cited for abuse. From 1999 to 2000, the
number of cases rose as much as 20 percent.
Experts and the GAO suggested that elder abuse cases may not get reported
because relatives or nursing home officials question a person's mental state or
because family members fear retribution. Plus, bruising and other skin
discoloring that come from abuse may be excused as a natural condition
associated with aging.
"I would say any change in behavior should be considered a sign," said
Aravanis. "If a normally outgoing person suddenly becomes withdrawn or
someone suddenly becomes very agitated, that's a sign of abuse."
Holes in Background Checks and Registries
In its report, the
GAO focused on three states with large nursing home populations — Georgia,
Illinois and Pennsylvania. The GAO report found that in the 158 cases reviewed,
26 nursing homes were cited for abuse-related deficiencies. One home was fined,
while other 25 homes faced lesser sanctions such as developing corrective plans
to prevent future abuse.
The three states the GAO reviewed required criminal background checks on
potential nursing home employees. But not all employees, such as maintenance
workers, are required to undergo background checks, and many are allowed to
start working before their investigation is completed. In addition, background
checks are often limited to an employee's record in one state alone.
State survey agencies have also set up nurse aide registries for caregivers
previously cited for abuse. But inconsistent registry updates, GAO investigators
found, nullified their effectiveness.
"As the nursing home population grows, I fear incidents like these will
grow more common unless we do more to ensure the quality of care for
residents," said Sen. John Breaux, Louisiana Democrat and chairman of the
aging committee. "We need to better train law enforcement officials to
address nursing home abuse, urge states to mandate all nursing home deaths go
through the coroner's office and implement other mechanisms to stop this
disturbing trend."
But is Better Policing Enough?
While the American
Health Care Association agreed that improvements could be made in how abuse
cases are handled, it worried that the GAO was suggesting that nursing homes are
not generally safe for the elderly.
Nationwide statistics show that slightly more than 2 percent of the
approximately 17,000 nursing home facilities nationwide were cited for actual
abuse of patients, according to the association. More often the facilities are
penalized for procedural violations.
"Suggestions that abuse is significantly higher than 2 percent, as depicted
in the GAO report, includes citations concerning policies and procedural
issues," said Charles Roadman, president and CEO of the AHCA.
Roadman argued that quality of care is often linked to the number of staff hired
to look after nursing home residents and he called on federal officials to set
an "optimal staffing standard" for nursing homes.
Still, advocates say better trained police and more nurses will not solve the
problem alone. Better-trained and continually trained staff may be the key.
"There must be more precise and universals guidelines set for what is
proper care and what isn't," said Aravanis. "We have to train people
on what is abuse and what is not. We have to have more background checks and
then psychological profiles to see whether some of these people can handle
caring for people who need intensive care. And it can't be a one-shot deal …
the training has to be ongoing."
According to The National Center on Elder Abuse, the signs and symptoms of abuse in the elderly vary but are not limited to different categories. Here is what to look for:
Physical
Abuse:
Bruises, black eyes, fractures and other unexplained injuries
Broken frames and eyeglasses
Caregiver's refusal to allow visitors to see victim alone
Sudden change in victim's behavior
Sexual
Abuse:
Bruises around breasts or genitalia
Unexplained venereal disease or genital infections
Unexplained vaginal or anal bleeding
Torn, bloody,or stained undergarments
Emotional
or Psychological Abuse:
Victim appears emotionally upset or inexplicably agitated
Victim becomes extremely withdrawn or non-communicative
Victim behaves in a way that suggests dementia
The National Center on Elder Abuse also says that any reports of abuse from an elderly victim should be taken very seriously. Officials say approximately two out of three abuse cases involve a relative of the victim who acts as a caregiver. Elder abusers typically have serious personal problems and may have also been victims of abuse themselves.
- Bryan Robinson - ABC News
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