Senior Safety

​Sadly, reports of seniors suffering from neglect and inadequate care in U.S. assisted living facilities are still common. One recent bombshell report, however, focuses on a more horrifying finding: some vulnerable seniors in U.S. nursing homes are being sexually abused by the people charged with caring for them. 

The study, Sick, Dying, and Raped in America’s Nursing Homes, is a CNN Special Report, and it finds that the problem may be more widespread than is generally acknowledged. More than 16,000 complaints of sexual abuse have been reported since 2000 in long-term care facilities—which include both nursing homes and assisted living facilities—according to federal data sources, the report says. Currently, about 1.6 million residents live in roughly 17,000 nursing homes across the United States.

The findings are quite troubling, but not surprising, says Julie Schoen, deputy director of the National Center on Elder Abuse at the University of Southern California’s Keck School of Medicine. “This is a part of elder abuse that nobody wants to talk about, and it needs to be addressed,” she says. 

The findings in the report come from various sources. Some information comes from civil and criminal court documents filed against nursing homes, assisted living facilities, and their workers. Other findings come from federal inspection reports filed by state health investigators; such reports are filed for the more than 15,000 nursing homes that receive U.S. government funding, such as Medicare and Medicaid reimbursements. CNN also conducted interviews with experts, regulators, and victims’ family members.

“The stories found in these reports range from sad to sickening,” the report’s authors say. Of the instances examined by CNN, the majority dealt with cases in which residents abused other residents. However, at least a quarter were allegedly perpetrated by aides, nurses, and other caregivers, and those cases tended to be far more serious forms of sexual assault. A smaller portion of the incidents involved facility visitors or unknown assailants. 

But even with all this research, CNN reporters say it is hard to pin down a fully accurate statistical picture of the extent of the problem. “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,” the authors find.

For example, the 16,000-plus number of complaints only captures cases in which state officials who advocate for facility residents were involved in resolving the complaints. The actual number of all complaints may be considerably higher.      

The report also found that, between 2013 and 2016, the federal government cited more than 1,000 nursing homes for mishandling or failing to prevent alleged cases of rape, sexual assault, and sexual abuse at their facilities. But again, complaints and allegations that don’t result in a facility citation (called a “deficiency” by the U.S. government) aren’t included in the reporting system. 

And state-by-state statistics reveal “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,” the report finds. 

For example, 386 incidents of sexual abuse have been reported since 2013 in Illinois, but only 59 were substantiated. In Texas, only 11 of 251 reported incidents in the 2015 fiscal year were substantiated. Wisconsin reported that it didn’t have a single substantiated case in the last five years. 

Moreover, many incidents don’t even reach the accusation stage. According to one U.S. government agency estimate, only about one in 14 elder abuse incidents are reported by the victim, Schoen says. 

When incidents are reported, a flawed process can make substantiation unlikely. “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,” the authors write. “Police viewed the claims as unlikely at the outset, dismissing potential victims because of failing memories or jumbled allegations.” 

For some facilities, funding problems negatively impact level of care. In many areas, reimbursement rates from government programs like Medicare are substantially below the actual cost of care, says Richard Meyer, a partner at Browning & Meyer, a law firm that specializes in elder law. 

In those cases, facility administrators are constrained in what they can pay staff, and that limits their ability to make quality hires. If the state doesn’t pay out enough, the quality of care suffers, Meyer says.  

The abuse problem has not gone unnoticed by state lawmakers in the United States, and a growing number of statehouses have recently been considering and sometimes approving legislation that sets out rules of operation for surveillance cameras—sometimes called “granny cams”—used to monitor residential rooms in senior facilities.  

As of last year, about six states had passed formal statutes and regulations regarding granny cams, with activity in other states “percolating,” says Jason Lundy, a partner at Polsinelli PC who specializes in long-term care and senior housing. 

Most of these state laws allow the use of granny cams if certain conditions are met. For example, cameras must be visible and all residents of the room must consent to their use, Lundy says. 

However, experts say there are also practical factors that may limit the use of these cameras, such as cost, installation issues, and the reality that some families would rather move a loved one to another facility, instead of installing a camera, if an incident happened. “I’m not so sure they’ve really caught on,” Lundy says.

While officials, investigators, and medical experts agree that sexual abuse in nursing homes can be challenging to detect and prevent, there is hope that the problem can be reduced. 

Experts recommend five best practices for facility managers and administrators: Investigate all claims, rather than dismissing those from “problem patients.” Preserve evidence, and don’t bathe or clean clothes or sheets when an assault is suspected. Maintain valid reporting systems for all complaints, with realistic substantiation requirements. Train staff to notice and correctly interpret observable signs of an incident. And beef up staff whenever possible, because these incidents are sometimes crimes of opportunity. 

In some cases, family and staff may underestimate the senior’s powers of agency because of his or her age, and thus fail to seriously consult them. But making an effort to engage and actively listen can also help prevent incidents of mistreatment and abuse from occurring. 

“Asking, ‘What would you like? Is that all right with you?’—that’s such a big issue,” Schoen says. “Many of them would love to give their opinion, if given the chance.”