MN- Nursing home abuses: Why?

12-14-2008 Minnesota:

Unsettling reports inspire broad look for what is amiss

Following shocking reports of physical and sexual abuse at Minnesota nursing homes, elder advocates and nursing home providers met Friday with one question on their minds.

What are we missing here?

While the abuse incidents don't reflect the compassion of most caregivers, they have state leaders re-evaluating everything from the "moral compass" of nursing assistants to the training they receive and the laws that regulate them.

At the Good Samaritan nursing home in Albert Lea, two former workers were accused of spitting at, groping and screaming at residents earlier this spring to make their jobs more fun.

"The Albert Lea situation is extraordinary because of the conspiracy of silence, the number of employees involved, the apparent planning or near-planning of the abusive activities, and the period of time over which the abuses occurred," said Darryl Shreve, a policy analyst for Aging Services of Minnesota, the trade group representing nonprofit nursing homes.

State investigations of nursing home complaints have increased: There have been 342 so far this year compared with 306 last year and 203 in 2005. Confirmed cases of physical, sexual or emotional abuse have held steady. Fifteen abuse cases have been substantiated so far this year, compared with 19 in all of 2007.

The complaint reports detail a wide range of cases, from a slap in one case to prolonged sexual and physical abuse by workers at nursing homes in Montevideo and Albert Lea.

Albert


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Lea is a case study of what happens when workers lose all respect for residents, said Dr. Robert Kane, a long-term-care expert at the University of Minnesota.
"Right now, they see themselves as sort of semi-gardeners or groomers whose job is to water and fertilize or whatever as opposed to caring for human beings and recognizing the humanness of these people," Kane said.

Kane credited the leaders at the Albert Lea home for providing mentoring to young workers and other training in the wake of the abuse incidents.

Two workers, Brianna Broitzman, 19, and Ashton Larson, 18, were fired and face criminal charges for the alleged abuse of vulnerable adults. Four other workers, all younger than 18, have been cited for failing to report the abuse, which didn't come to light until one worker mentioned it during an exit interview.

Kane said he sees a cultural change taking place in the creation of smaller four- or eight-bed nursing homes in which residents and workers develop closer bonds. If that spirit can be fostered in larger facilities, he suspects, they will be able to recruit more workers who care about residents.

"If you're making cookies with them," he said, "you look at them differently than if you're just wheeling them down to dinner."

Part of the problem is the rapidly changing environment of today's nursing homes. Many seniors are staying home with support services as long as possible, leaving nursing homes mostly with residents who are frail and suffering dementia.

The majority of nursing home residents abused this year had some form of dementia, according to state reports. These residents not only suffer confusion, but their loss of memory and communication skills can also make them belligerent. In a couple of instances of abuse, staff members hit residents who had hit them first.

Investigative reports of a worker hitting a resident at another Good Samaritan home in Windom showed that the worker felt justified. The worker has since been fired and charged with abuse.

"(The resident) strikes out all the time and has given me a bloody nose. I just feel like I have a right," the worker told investigators, according to the report. "I know he's a vulnerable adult. It's hard working with someone that's continually abusive all the time."

Nursing homes must at least comply with a 2003 law to train caregivers on the challenges of caring for dementia patients, said Mark Wandersee, executive director of the Elder Care Rights Alliance. Some are going further by conforming their schedules to residents' quirky habits to make them more comfortable and less likely to lash out.

"Elder abuse is where child abuse or domestic abuse was 30 to 40 years ago," Wandersee said. "Nobody wanted to talk about it."

The encouraging sign following the Albert Lea news is the amount of discussion that has emerged. A national elder-care advocate held a forum in the southern Minnesota town Thursday night. About 50 people showed up to express concerns.

Wandersee's advocacy group was part of Friday's meeting with the leaders of Minnesota nursing home organizations. Ideas discussed included more training for law enforcement on elder abuse and lists of abuse warning signs that could be distributed publicly.

While the abuses are inexcusable, the Albert Lea case has gained unusual attention because the workers were identified through police reports and their "prom queen" photos were published in the media, said Patti Cullen of Care Providers of Minnesota, the trade group for for-profit nursing homes in the state.

"I'm hoping it's a media frenzy that's an opportunity to change things," she said.

Part of the shock in Albert Lea has been the age of the workers. Minnesota law allows anyone 16 or older to work as nursing assistants if they complete a basic training course or agree to do so upon employment.

At least half of other states set the age limit at 18.

Cullen and others in nursing home care were resistant to raising the age limit, particularly at a time when good nursing assistants are hard to recruit and retain. Many of the best caregivers entered the profession at young ages, she said.

Aging Services of Minnesota is offering a higher-level degree program that elevates nursing assistants to health-support specialists.

Pine Technical College offers a virtual reality simulator that puts nursing assistants in real-life scenarios and challenges them to remain calm and happy while making quick decisions.

"The retaliation against a resident with dementia who lashes out is prohibited," said Shreve, of Aging Services. "How do you prevent it? Training, training, training. But if you're a female nursing assistant providing care to a male resident who suddenly and without warning grabs your breast, the instinctual response might not be the best one.

"The training needs to emphasize watching for signs of agitation, aggressiveness, combativeness, etc., and to stress that you back away from the resident while trying to calm them down."

The U's Kane said training is important. But the latest abuse cases suggest the need to change the entire environments in which caregivers work.

"These are markers," he said, "of the need for a larger revolution." ..News Source.. by Jeremy Olson