Nursing-Home Assaults Skyrocket in Mass.
By Kay Lazar
Originally published in The Boston Herald, March 17, 2002
Reports of sexual and physical assaults on nursing-home residents—often by other patients—have risen dramatically in Massachusetts over the last several years, a potent problem one industry expert says is "waiting to explode."
Just Friday, the 109-bed SunBridge Care & Rehabilitation facility in East Boston closed after numerous instances of serious assaults.
In one case, a man suffering from manic depression and dementia was admitted to the nursing home—despite his prior convictions for sexual abuse, burglary and assault. He was supposed to be closely monitored, yet records show that the patient repeatedly attacked other patients and eventually ripped a toilet off a wall.
At the same nursing home, another male patient hurled a metal chair at a female patient, blackening her eyes and cutting her nose.
With the state Department of Public Health moving to yank its certification for Medicaid and Medicare funding, the facility shut its doors Friday.
But the chilling reports of abuse are hardly unique to the East Boston nursing home. State records show reported physical and sexual assaults—most often by patients abusing other patients—are rising in nursing homes across the state.
Reports of physical abuse rose 40 percent between 1999 and 2001 and incidents of sexual abuse increased by 129 percent during that same period. Overall, reports of abuse went up 50 percent between 1999 and 2001.
"The sad thing is that the majority of these resident-on-resident abuses are totally preventable," said Ilene Henshaw, a nursing home specialist with the AARP. "In the majority of cases where there is a violent situation, it can be headed off with good supervision."
Starkly illustrating that point is a case last August at the SunBridge nursing home in Lynn, where a 29-year-old brain injured patient gouged out the left eye of a 38-year-old brain-injured patient while she sat helplessly in her wheelchair. State records indicate that staffers were supposed to be checking on the 29-year-old every five minutes but he was not checked for at least four hours prior to the attack.
State officials say that since then, SunBridge has done a good job of beefing up staffing, training and programming at its Lynn facility to ensure patients' safety.
But the problem, according to experts and several recent reports, is that supervision, staffing and training at many of the state's 500 nursing homes is so inadequate the situation has hit a crisis point. And, some say, it threatens the very safety of the 50,000 residents in these facilities.
"What you have is a potent problem waiting to explode," said Ernie Corrigan, spokesman for the Massachusetts Extended Care Federation, the trade group that represents most of the state's nursing homes.
"The (staff) turnover rate is mindboggling," said Corrigan, referring to a Feb. 7 report by the American Health Care Association that found that more than 50 percent of nurses and nurses aides in Bay State nursing homes fail to make it even one year at a facility before leaving. Corrigan and others say low pay, measly benefits, unsafe working conditions and lack of training are major reasons.
"You are constantly bringing in new employees, who don't know the residents, don't know their good days and bad days and really haven't learned how to keep things in check," Corrigan said.
Certainly Theresa Keenan-Vartanian of Braintree found out just how badly things can spiral out of control.
Her beloved 90-year-old grandmother, Mary Keenan, died in December 1997 after being punched in the back of the neck by a 35-year-old resident in the Quincy nursing home where both lived and were roommates. The blow knocked Keenan to the floor.
State investigators later reported that the 35-year-old stroke patient previously assaulted a number of other residents and that staffers had referred to her as a "time bomb," but that the nursing home had failed to monitor her and "failed to provide staff the necessary information that might have prevented the fatal assault."
Today, Keenan-Vartanian said she is still haunted by the fatal assault on her grandmother, who entered a nursing home because she was afraid of living alone after suffering a mild stroke.
"You put someone in a place like that because you expect them to be cared for," she said. "The worst thing was not being able to say goodbye to her. She went out the one way she was most afraid of—being by herself and falling."
The Quincy nursing home closed in 2000, and the company that owns it, SunBridge Healthcare Corp. of Albuquerque, N.M., recently settled a $750,000 lawsuit with the Keenan family.
While not commenting specifically on the Quincy case, SunBridge spokeswoman Patricia Kennedy said the company recently launched a new program in its nursing homes nationwide, including its 32 facilities in Massachusetts, to hire and retain better trained staffers. The program includes tuition reimbursement for nursing school and financial bonuses.
Although SunBridge cases have made headlines, state officials say the problem of nursing home residents harming other residents reaches well beyond the company's chain.
For instance, state investigators are probing a Lowell nursing home after a nurse allegedly caught an 83-year-old male stroke patient on Jan. 5 fondling the genitals of an 81-year-old female who suffers from Alzheimer's, Parkinson's Disease, depression and anxiety disorder. The state Department of Public Health declined to release the name of the facility, citing an open police investigation into the incident, but did say it was not owned by SunBridge.
"It starts right at admissions and the assessment that's done, to determine whether the facility has the resources and trained staff to deal with a patient with behavior problems," said Jean Pontikas, assistant director of the division of health care quality at the DPH. "We think there are problems in this area. In some incidents, they admit residents they can't care for because they don't have the resources to keep residents safe."
Pontikas said reported incidents of resident-on-resident abuse rose sharply after the state added new guidelines and training in 1999 to help nursing home staffers better detect and report abuse.
Now state officials, working with outside researchers, are poring through hundreds of the reported abuse cases to figure out whether there are common warning signs that would help officials develop guidelines for nursing homes to better detect the abuse—before it occurs.
One aspect the state should study first, say elderly advocates, is the lack of staff training, specifically for patients with Alzheimer's or dementia. Experts say that more than half of nursing home residents suffer from some form of dementia.
"In Massachusetts, we require 1,500 hours of training to cut hair and only 75 hours to be a (nurses aide), and of that 75 hours, less than four hours are specifically spent on how to deal with dementia patients," said Paul Raia, director of patient care with the Massachusetts Alzheimer's Association.
Connecticut's former Ombudsman, who investigated nursing home complaints, said that the limited training nurses aides do receive in Massachusetts for dementia patients sorely misses the mark. Nurses aides are among the lowest paid workers in facilities but are responsible for the feeding, bathing and most of the hands-on care of residents.
"The training is set up to memorize certain facts and past tests. Particularly when you realize this is about human care and day-to-day situations, there really needs to be a build up of that in the training," said Barbara Frank, director of state health policy for the Paraprofessional Healthcare Institute, a trade association for nurses aides and other health care workers.
When serious physical or sexual abuse does occur in nursing homes, local law enforcement are seldom summoned to the facilities to immediately investigate, according to a federal report on the nation's nursing homes released March 4.
In Massachusetts, nursing home operators are required to immediately report suspected abuse to the state's Department of Public Health, which notifies the Attorney General's office. While the DPH advises nursing home operators to also contact local authorities, there is no state law or regulation requiring the operators to do so, according to the DPH.
Advocates for the elderly say that's a serious oversight.
"Any kind of abusive situation that causes injury should be reported," said the AARP's Henshaw. "A crime is a crime, whether it occurs in a nursing home or on the street. Just because you become a resident of a nursing home does not mean you leave your rights at the door."
Two years ago, when public outrage over serious neglect cases at nursing homes reached a fever pitch, state lawmakers approved a modest wage increase for nurses aides, aimed at attracting and keeping more in the profession. Industry leaders say it was a start, but not nearly enough to make a substantial difference. Now, they say, there is a serious shortage of licensed nurses.
It was hardly the first time state officials studied the troubled nursing home industry.
In 1963—after an eight-month, $135,000 study—a legislative commission concluded that, among other things, the industry lacked quality workers because of the low pay and benefits.
"It's one of the areas society doesn't care enough about to change," said Phil Mamber, president of the Massachusetts Senior Action Council. "Just imagine with the tremendous number of retirements with the baby boomers. Just imagine 10 to 15 years from now the size of the problem."
