Elizabeth Leis Newman

In the most comfortable of circumstances, it can be difficult to discuss sexual assault. Mention it as an issue in long-term care, and even seasoned administrators wince.

Unfortunately, three high-profile cases involving sexual assault of a long-term care resident hit the news this month, one each in Kansas, New York and Minnesota, making it a relevant topic begging for discussion. The last case is especially horrific because the Minneapolis Star Tribune hunted down court records indicating the caregiver admitted to having sex with the 89-year-old resident, and that the victim was kept in a locked psychiatric ward for a few days while there an investigation was undertaken. According to the court testimony, when asked about the rape, the clinical services director said, “Did she tell you that this was consensual? Did she tell you that she flirts with this boy mercilessly?”

If you ever need an example of the absolutely wrong thing to say, and of a terrible human being, see above.

The place to start for nursing home administrators, in my opinion, is remembering that sexual assault is less about sex, and much more about power, especially over someone who is vulnerable. If you reframe rape and sexual assault in that way — as opposed to someone having sex with an elderly person — it can help staff understand how such horrific incidents occur.

To be fair, there isn’t evidence of widespread sexual abuse across the long-term care setting. But administrators, nurses and other managers have to make sure all staff members understand how serious abuse allegations are, reminds Susan V. Kayser, a partner at Duane Morris in New York who specializes in health law.

No matter the circumstances, “What stays the same is that the resident comes first. Remembering that the nursing home’s obligation is to the resident is a principle issue whether or not there’s clear-cut evidence,” she says. “You have a resident who has made a serious allegation. That’s where we are starting.”

In ProPublica’s database of Nursing Home Compare deficiencies, allegations involving the world “rape” are mentioned 400 times. Unsurprisingly, what often got facilities into trouble was a lack of documentation. In one incident in 2013, a resident at a California facility was regularly delusional and had said in back-to-back months that she was raped. But there was still a citation under F-tag 226 because when the resident made the second allegation of being sexually abused, there was no documentation indicating she had been interviewed, no examination and no record of the manager talking to other people on the floor about the specific incident.

No matter what the circumstances are, the best protection is for nursing homes to take allegations of abuse seriously, Kayser says. If the accused is a staff member, he or she is generally suspended pending an investigation. This is true even if a resident has dementia, even though it’s clear from the database that cognitive impairment may result in a resident’s allegations being ignored.  

“I would hope that without regard to the cognitive status of the individual that the nursing home would take the allegation seriously. You don’t know. It’s not like every utterance is without basis at all,” Kayser notes.

She also reminds that training and statement of policies is important.

“Make sure the word is out that management will not tolerate inappropriate behavior.”

That’s true not just for staff, but volunteers and external healthcare workers coming into the facility. In one 2011 case, a volunteer of five years was alleged to have made “inappropriate sexual contact” with a resident, but the volunteer noted he never received any sort of training regarding resident rights and abuse protocols. In another 2011 case, a lab technician went to draw blood from a resident, and began undressing the resident and himself without her consent, ultimately forcing her into committing an unwanted sexual act, according to the police report. It was discovered the lab tech had already had another complaint from a female resident, and the facility received an immediate jeopardy tag.

Finally, in any circumstance involving such as serious crime, it’s important for staff to reach out to family of the resident, Kaiser reminds.

“With respect to practical considerations I think being in touch with the family and expressing concern is very important as well,” she says.

Elizabeth Newman is Senior Editor at McKnight’s. Follow her @TigerELN.