Sex abuse cases involving senior living staff against residents often are as baffling as they are complex, making it difficult for operators to respond effectively and humanely to the incidents, and ensure that they do not occur again.
And of course, the way a senior living provider reacts to allegations of abuse at the hands of a staff member is just as important as the steps taken to prevent such incidents from occurring in the first place.
Given the sensitive and serious nature of these cases, the need for senior living providers to have strong policies and procedures in place is obvious — and has been further highlighted as several providers recently have had to deal with the issue in public, following news reports.
There was the incident in Cedar Hill, Texas, wherein a senior living employee was found with his pants down in a 76-year-old resident’s bed. And in Mint Hill, N.C. an assisted living worker was charged with a first-degree sex offense against an 86-year-old resident.
Despite these high-profile cases that pop up in the local news nationwide, one reason that providers might be caught off guard is that it’s difficult to know exactly how common incidents of sex abuse crimes against residents by employees are, says Julie Schoen, deputy director of the National Center on Elder Abuse (NCEA), noting that it is an “understudied and underreported issue.”
Complicating research efforts are often residents, who may be too frail or lack the mental capacity to report crimes. But the more steps providers take to prevent abuse against residents, the better equipped they will be to respond to allegations of abuse.
“We need to start raising more awareness about this topic,” Schoen says.
1. Screen for ‘Bad Actors’
The first line of defense operators have against “bad actors” entering their communities is through their hiring practice, says Meredith Duncan, attorney with Polsinelli P.C. Duncan specializes in legal and regulatory matters relating to senior living.
“Screen your staff as required by law and by using every tool in your arsenal to make sure the [applicant] doesn’t have a history of sexual offense,” Duncan tells SHN. “Ultimately, you have to do everything you can to make sure staff are the proper, qualified people to be there.”
National provider of memory care, assisted living and home care Silverado takes steps to screen current and prospective employees for their aptitudes, which includes “integrity testing for all candidates, and comprehensive associate training for handling situations that could lead to abuse claims,” Nathan Levoit, vice president of Silverado’s human resources department, tells SHN.
Going above and beyond is key, as even if all mandatory hiring protocols are followed, providers can still face challenges when trying to obtain the true history of an applicant, Schoen says.
“There have been discussions of having an elder abuse registry, similar to a child abuse registry,” she says, adding that it can be especially difficult to learn about past criminal history if the applicant was not convicted. “With the registry, providers would have more knowledge about who they’re hiring.”
The industry’s high rates of employee turnover have an impact on the applicant pool as well, Schoen says.
“The turnover is so high, and wages so low,” she says. “These people are taking care of our parents and grandparents. Yet, it’s difficult to know who you’re bringing on staff.”
2. Implement Ongoing Training
One way to ensure employees understand what is expected of them and provide the highest quality of care is through ongoing training.
At Silverado, ongoing education is provided for associates to be on alert to risks that could lead to abuse claims, creating an environment where teams are focused on providing the best care possible, Levoit says.
“Our abuse prevention and training practices exceed requirements and we have seen positive results from instituting these hiring tools,” he says, noting that the company aims to create a culture where associates are “empowered to discuss any concerns directly with senior leadership.”
3. Start Communication On Day 1
Having an open, ongoing dialogue with both staff and residents — and residents’ families — about what abuse looks like, and how to address it, is key to ensuring everyone’s safety, Duncan says. The more that residents and their loved ones understand the way a facility provides care, the less likely they are to make false allegations due to a lack of understanding.
“Whether it’s assisted living or skilled nursing, a lot of people admitted to these facilities are not used to receiving the care these facilities provide,” she says, citing bathing assistance from someone who is not a family member as an example. “People who have memory problems could be interpreting care as abuse, or don’t speak up to say that something is too rough.”
Staff should explain to residents what they are doing each step of the way to ensure the resident understands what is happening.
“Staff might perform a certain task over and over again, but it might be the first time a resident needed help in the shower,” she says, stressing the importance of documentation. “Staff need to perform the task in a way that protects the resident’s dignity.”
In addition, if family members are concerned, invite them to be present when a resident is being cared for, Duncan says, noting that is “another strategy to make sure everyone has the opportunity to speak up and direct what happens.”
Ultimately, the best strategy is to be “open with families from the outset,” she says.
“The ongoing discussion with residents and their families should be, ‘If anything gives you any discomfort, please come to us,’” she says. “Hopefully it will give them the confidence to go to that person whether it’s regarding quality of care issues or abuse.”
Written by Cassandra Dowell