Alliance Aims to Halt Elder Abuse
BOSTON (ANS) -- In May, a nursing home worker in Attleboro, Mass., pleaded guilty to fondling the breast of an 81-year-old resident of the Ridgewood Court Nursing and Rehabilitation Center. The man received an 18-month suspended sentence, lost his nurse's aide license and was barred for life from health care work in Massachusetts. But his career is not necessarily over. He could seek a health care job in another state, and there would be no easy way for a prospective employer to trace his criminal past. This summer, Sen. Herb Kohl (D-Wis.) plans to file federal legislation creating a national system of criminal background checks for elder care workers. According to a spokesman for the American Health Care Association, 29 states require criminal record screening of some or all applicants for jobs in nursing facilities, and 13 other states have legislation pending. But no national database exists. "It is difficult for states to share information," said Kohl spokeswoman Lynn Becker. Meanwhile, prosecutors around the country are trying to beef up training of nursing home workers as one way of preventing elder abuse. In Massachusetts, a groundbreaking alliance of prosecutors and nursing home industry officials has emerged as a national model for elder abuse prevention. The alliance between the Massachusetts Extended Care Federation and state Attorney General Scott Harshbarger's office yielded an innovative program for nursing assistants statewide. Drawing on a broad definition of abuse that embraces psychological and emotional abuse and neglect as well as physical abuse, the Massachusetts training program uses a video and booklet with role-playing scenarios to help nursing assistants understand the plight of elderly residents. By sitting in a wheelchair and pretending to have physical limitations, for example, a nurse's aide might think twice about raising her voice the next time an elderly patient pleads infirmity. Petra V. Langer, spokeswoman for the Massachusetts Extended Care Federation, said federal regulations require additional elder abuse prevention training for all facilities receiving Medicare or Medicaid money -- a mandate that can be fulfilled using the hour-long video and companion booklet developed by the federation and the state attorney general's office. Langer said some 450 Massachusetts extended care facilities, or about 80 percent of such institutions statewide, have so far received the abuse-prevention training materials. In Somerville, Mass., Sister Catherine Frain of the Geanne Jugan Residence credits the state-led training program with broadening her staff's definition of abuse to include ignoring residents, violating their privacy and yelling at them. "Training is vital," said Frain, whose facility is run by the Little Sisters of the Poor, a religious order of nuns. In addition, she said her nursing home-assisted living facility has recently begun conducting criminal background checks on prospective employees, a practice that is becoming widespread nationwide as state legislatures strengthen screening standards for extended care facilities. Ora DeJesus, associate professor of nursing and director of the gerontology center at the University of Massachusetts at Dartmouth, supports the Massachusetts model but says the state's overall requirement of 75 hours of training is inadequate. "We're letting them go and learn on the job," DeJesus said. "Is that really fair to our elder clients?" She pointed out that Maine, for example, requires 150 hours of training, twice the federally required 75-hour minimum. The National Association of Attorneys General, which Harshbarger chaired until June, and the American Health Care Association plan to copy the Massachusetts program nationally. To date, 25 attorneys general have added statements to the training video "Keeping Nursing Facility Residents Safe." The training received by workers, like the video that will soon get national distribution, stresses basic concepts that harried nursing home staffers may sometimes forget -- for example, taking five whenever job pressure mounts, rather than initiating a hasty, perhaps hurtful, action. "A lot of people don't understand that little things can abuse a person," said Nancy Roache, a nursing assistant at Marian Manor, a private 366-bed nursing home in South Boston, who hopes to study to become a registered nurse. "When you turn your back on a person, that's abuse." According to the National Center on Elder Abuse, a Washington think tank and advocacy group, as the population of seniors has ballooned, the number of domestic elder abuse reports nationwide has more than doubled from 117,000 in 1986 to 241,000 in 1994. The center says that nearly two of every three victims were women, and the majority of abuse reports stemmed from alleged neglect, not physical abuse. Abuse within American nursing facilities, where some 1.5 million elderly and disabled people reside, is hard to quantify. The federal Administration on Aging, which tracks abuse allegations, lumps together all complaints about extended care facilities, from cold food to physical abuse. The agency logged 218,000 such complaints nationwide in fiscal year 1995. Extended-care ombudsmen, required in all 50 states under amendments to the Older Americans Act, resolved about three of every four of these complaints, the agency reported. In Massachusetts, overall abuse reports skyrocketed from 1,529 in 1984 to 5,625 in 1996. "I do believe that reporting has become much more acceptable than it used to be," said Ora DeJesus, the University of Massachusetts gerontology center director. Along with more frequent reporting, elder abuse prosecutions have increased twentyfold since 1991, said Michael T. Kogut, assistant attorney general for elder protection in Massachusetts.[EDITOR: OPTIONAL TRIM NEXT 5 GRAFS.]The prosecution of John L. Pascua, the man convicted in May, was part of a stepped-up enforcement of anti-abuse laws by Massachusetts Attorney General Harshbarger, who is running for governor. In announcing the guilty plea in a May 8 press release, Harshbarger's office cited a visitor who "witnessed Pascua fondling the breast of an 81-year-old female resident as he kissed her on the mouth." Pascua, 58, is now barred from working even as a volunteer in any sector of Massachusetts health care and will have to register with local police as a sex offender wherever he lives and works in Massachusetts. The director of Ridgewood Court, which suspended Pascua after the initial charges, did not return repeated calls seeking comment. Reached at a supermarket in Seekonk, Mass., where he is now working as a meat cutter, Pascua claimed he was innocent. He said he pled guilty only to avoid prison and because he didn't have the money to hire a private attorney. "I was undressing the lady to wash her and kissed her on the cheek," he said of the incident in a telephone interview. "There's a lot of hysteria out there. Workers are getting the shaft. I've had to pay a heavy price," he said, adding that his wife has divorced him.[END OF OPTIONAL TRIM.]Arvid Muller, a researcher with the Service Employees International Union in Washington, D.C., said much of the abuse by nursing assistants and other employees in extended care facilities stems from understaffing, insufficient job training, high turnover and stressful workplaces with high injury rates. "It's easiest to blame the aide when the problems are much more systematic," Muller said. Muller said the SEIU, representing some 100,000 nursing home workers nationwide, has called for reforms such as allowing no more than 8 to 15 residents per nursing assistant. Another solution the SEIU has already implemented in some facilities, Muller said, is the formation of management-staff resident care committees involving direct care workers in nursing facility decision making. Ultimately, Muller argues, extended care residents won't get the treatment they deserve until staffers are allowed to spend more time with each resident. "Residents are not getting their full level of needs met," Muller said. At Marian Manor in South Boston, where most residents receive Medicare or Medicaid benefits, nursing assistant Roache cares for 10 or so residents in a locked-down Alzheimer's unit. Roache, 24, said she first learned about abuse prevention while securing institutional care for her brother, but she said the state's emphasis on role-playing exercises in her training three years ago has helped her understand what is acceptable conduct and strengthened her ability to empathize. Marianne Vitale, nursing director at the Sutton Hill Nursing and Retirement Center in North Andover, Mass., said the training program has helped her staff cope with the stresses of caring for seniors. "Everyone needs gentle reminders about tone of voice and the way you approach a confused resident," Vitale said. "I really think we're all being proactive." Now when Vitale sees nursing assistants race down the hall at her 142-bed facility, she stops them and asks how their day is going. Vitale routinely covers a floor so a stressed-out employee can take a soda break, she said. The key to managing stress when dealing with demented residents, Roache said, is to "just keep smiling" at the seniors. "I have a lot of things going on in my life, but I leave it at the front door," Roache explained. "By the end of the day, they're smiling with me."SIDEBARMajor Conference on Elder Abuse Slated for September(ANS) -- Finding ways to prevent financial exploitation of vulnerable nursing home residents will be among the goals of a major conference on elder abuse Sept. 3-4 in Albany, N.Y. The conference, entitled "Many Voices, One Song: Protecting Vulnerable Adults," is slated to bring together lawyers, law enforcement officers, health care workers and social service professionals for networking and professional development sessions. Anne Corre, training associate at the Brookdale Center on Aging at Hunter College, said one of the innovative components of the conference will be a workshop on detecting and stopping financial exploitation of elders. Brookdale is co-sponsoring the conference with a coalition of New York State agencies. Citing one problem, experts say seniors are often pressured into signing over money to family members, caregivers and others. One solution to be explored at the conference is to give bank employees more power to refuse withdrawals if they suspect coercion. Other forums are scheduled to give participants primers on protective services, domestic violence and the elderly, dealing with dementia and preparing elder abuse cases for prosecution. "There's a lot of opportunity to take advantage of older people," lamented Corre. For more information, contact the Brookdale Center at 212-481-4426.