Institutional Care: America's Most Vulnerable Seniors Raped and Sexually Abused

The headline alone is nauseating.  "SICK, DYING AND RAPED IN AMERICA'S NURSING HOMES," screams the headline of the recent CNN report detailing the incidence of sexual assaults in America's nursing homes, and the indifference of the government and regulators to the epidemic of violence visiting the most vulnerable in America's nursing homes. The facts elicited by CNN reporters in individual cases sicken and disturb. 

That such a story even exists is maddening.  More than 16,000 cases of sexual abuse have been reported in nursing homes and assisted living communities since 2000, according to the CNN report.  But the figures do not tell the complete story.  They don't even come close. The reason is that the government does not specifically track sexual abuse.  Despite the frequency, and indeed, the devastating impact upon victims and their families, state and federal government simply does not track or keep statistics of sexual assault.  CNN explains: 

Despite the litany of abuses detailed in government reports, there is no comprehensive, national data on how many cases of sexual abuse have been reported in facilities housing the elderly.

State health investigators examine all types of abuse reported at nursing homes and assisted living facilities, whether reported by the facilities or flagged by complaints to the state from witnesses, family members or victims. In the case of nursing homes, state officials typically conduct these investigations, as well as routine inspections, on behalf of the federal Centers for Medicare & Medicaid Services (CMS), which regulates the more than 15,000 facilities that receive government reimbursements that pay for many residents' care. Both state health agencies and the federal government then use the information to rate facilities and issue financial penalties for the worst offenders.

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CNN surveyed the health departments and other agencies that oversee long-term care facilities in all 50 states. Of the states that could provide at least some data, the responses varied widely. 

Illinois, for example, said 386 allegations of sexual abuse of nursing home residents had been recorded since 2013, 201 of which involved a caretaker. Hawaii said eight allegations of sexual abuse were investigated between 2011 and 2015 -- five of which involved a caregiver. And when states provided a further breakdown of how many allegations had been substantiated, the results demonstrate just how few accusations end up being proven -- whether it's because of the extreme hurdles posed by aging victims, the destruction of evidence, or half-hearted investigations by facilities and regulators.

Of the 386 cases in Illinois, 59 were considered substantiated. And in Texas, 11 of 251 sexual complaints in the 2015 fiscal year were substantiated. Wisconsin said it didn't have a single substantiated report of abuse in the last five years.

But most states could not say how frequently abuse investigations involved sexual allegations, often stating that sex abuse allegations are not categorized separately from other forms of abuse.

The federal government doesn't specifically track all sexual allegations either.

The reported figure comes from federal data maintained by the U.S. Department of Health and Human Services' Administration for Community Living (ACL), the cable network said, noting that ACL officials said that it includes only cases that involved state long-term ombudsmen.

To arrive at the figure reported, CNN reviewed civil and criminal court documents, state health investigations and CMS information (which included data only on nursing homes), and also interviewed experts, regulators and the families of victims. Although the investigation focused on nursing homes it also addressed assisted living communities, singling out two specific cases.

In one such case, a former cook at a Louisiana assisted living community,  was indicted and charged with first-degree rape of a resident. An executive at the community has also been charged for  failing to report abuse of adults and obstruction of justice, a charge she and the community that hired her denies.  

CNN also cited a 2013 case in Minnesota in which an 89-year-old assisted living resident with dementia was transferred to the mental health ward of a local hospital after she said she had been raped. A certified nursing assistant said he had consensual sex with the resident, and a director at the community believed him, according to CNN.

Most of the report focused on the abuse in nursing homes.  Before reciting specific, repeated, and heart-wrenching details of case after case, the news organizations made a stark and horrific assessment of its findings:

The unthinkable is happening at facilities throughout the country: Vulnerable seniors are being raped and sexually abused by the very people paid to care for them.

It's impossible to know just how many victims are out there. But through an exclusive analysis of state and federal data and interviews with experts, regulators and the families of victims, CNN has found that this little-discussed issue is more widespread than anyone would imagine.

Even more disturbing: In many cases, nursing homes and the government officials who oversee them are doing little -- or nothing -- to stop it.  

Sometimes pure -- and even willful -- negligence is at work. In other instances, nursing home employees and administrators are hamstrung in their efforts to protect victims who can't remember exactly what happened to them or even identify their perpetrators.

In cases reviewed by CNN, victims and their families were failed at every stage. Nursing homes were slow to investigate and report allegations because of a reluctance to believe the accusations -- or a desire to hide them. Police viewed the claims as unlikely at the outset, dismissing potential victims because of failing memories or jumbled allegations. And because of the high bar set for substantiating abuse, state regulators failed to flag patterns of repeated allegations against a single caregiver.

It's these systemic failures that make it especially hard for victims to get justice -- and even easier for perpetrators to get away with their crimes.

According to the report, perpetrators get away with their crimes in too many instances, sometimes through the intentional or negligent handling of the nursing homes themselves. Some perpetrators are first reported by other employees for assaults upon them, causing the nursing home to treat the issue as a labor matter, leaving vulnerable residents under the perpetrator's care. If you want to read more about the specific cases, go here.  The news network recommended that facility owners and operators investigate all incidents, preserve evidence, train employees on reporting practices, and employ sufficient staff to enable proper supervision of workers.

If you are a senior, a family member of a senior, or a caregiver, advocate, or fiduciary for a senior, it is imperative that you evaluate carefully institutional care.  Sexual abuse is only one of many risk factors about which you should be aware. This blog has included articles detailing many of these risk factors, warning that institutional care should be a last resort, and not an ordinary health care option as it is utilized by Medicare, Medicaid, and the current health care system.  These articles include the following:  

• COPD Patients Discharged to a Skilled Nursing Have Two Times the Risk of Death Within Year Compared to Those Who Go Home
• One-Third of Nursing Home Residents Injured or Killed In Treatment
• Hapatitis Infection Risk in Nursing Homes Up 50%; Infection Risk Across the Board Increases
• Resident's Death Caused By Nursing Home Failing to Follow Advanced Directives Requesting CPR
• Nursing Home Involvement in Patient's Death Object Lesson on Aging-in-Place Planning
• Nursing Home Worker Faces Homicide Charges in Violent Death of Resident
• Paramedics Often Obstructed, Provided Insufficient Information On Nursing Home Calls
• Hospice Patients in SNFs Less Likely to be Visited by Professional Staff the Last Two Days of Life
• Non-Profit Long-Term Care Safer than For-Profit
• Nursing Home Residents Twice as Likely to Suffer Fractures
• Habits Are Hard to Break: Nursing Homes Habitually Violate Federal Standards Year After Year
• CDC Reports That SNF Workers Most Likely Among Health Care Workers to Forego Recommended Vaccinations
• New Controversial Sign-Off Rule Increases Burdens On Skilled Nursing Facilities- Threatens Transfer To Hospitals
• Don't Let Institutions Plan for You: Medicaid-Eligible Nursing Home Resident Stuck With Costs of Private-Pay Room
• Many Skilled Care Providers Still Unaware of New Medicare Rules Permitting Chronic Condition Care
• Ohio Ranks Poorly on Long-Term Care Services Scorecard
• Hospice Costs Medicare Less Notwithstanding that Hospice Patients Live Longer

You should ensure that you, or those for whom you are or may be responsible,  adopt a comprehensive estate plan adopting and implementing an "Aging in Place" plan, and providing both guardianship planning and guardianship protection. Guardianship and institutionalization are cruelly related in that court appointed guardians often prefer institutional care for their wards, and institutions often refer residents for guardianship. For more information regarding the risks associated with guardianship, visit the National Association to STOP Guardianship Abuse.  Among the best planning tools developed to avoid the risk of institutional care is avoiding institutional care altogether. 


If you want to attend in person or online a seminar on "Aging in Place," its meaning, its importance, and how to incorporate it into your estate and financial plan, simply send us an email with your name and location.