There is a nearly invisible injustice occurring in the United States today. It’s a subject no one ever wants to think about: rape. But, more than that, it’s happening to someone we never thought it would: our parent. Namely, our mothers and grandmothers. Even more, it’s happening in a place we never thought it would: their nursing home. Yes, we have heard the nursing home horror stories of inadequate care, but this is more evil and horrifying than even those news headlines.

Recently, CNN Investigations published an exposé that brought up an important yet disturbing fact: most elderly rape cases in assisted living facilities and hospitals are never reported to authorities. Many aren’t even investigated. They are simply forgotten and again (like we’ve seen in other claims of rape), victims are blamed. There are many reasons given for why a facility leaves the case unsolved: She has dementia. It must have been a delusion, a hallucination. She doesn’t even remember what exactly happened. He doesn’t have a record of abuse…

The unfortunate truth, though, is that many of these perpetrators who work in these facilities have worked there for years and will continue to work there for many more years because there is no appropriate method of response. One perpetrator lied to a nursing home during his hiring process, and then later raped an elderly woman. He did not disclose the previous allegations of sexual assault against him at other facilities, and there were a number. Why are these nursing homes and hospitals not fully vetting their employees? Why are reports of abuse going undocumented? Why is the most evil of acts against the most vulnerable going unpunished? Why aren’t our elders protected in the places they live, the places they call home, by the people who are meant to care for them at the most intimate level?

There are recent reports on this horrific phenomenon that might help us get closer to the answers. Dr. XinQui Dong, MPH writes, “evidence suggests that one in 10 older adults experiences some form of elder abuse, but only one in 25 cases is reported to social services agencies” (Dong, 2012). Elder abuse includes many different kinds of mistreatment, and this is not just referring to sexual assault. But, the silence around reporting is a damage-inflicting status quo that needs correction.

The American Academy of Nursing on Policy said in 2015 that “elder mistreatment is a major national health concern.” This is especially important because it can be “contagious” in families and in certain environments. This is also because the elderly population is growing in size every day and baby boomers are slowly transitioning into being the largest elderly population our country has ever seen. This could lead to overcrowding of assisted living facilities and a lack of experienced medical and care professionals in those environments as well as lack of care at home, which could make elderly abuse an even bigger problem.

Even though nurses and other health care professionals would be perfectly-positioned people to keep watch over the elderly and report any sign of neglect or abuse, “they are…among the least likely to do so” (Schmeidel, Daly, Rosenbaum, Schmuch, & Jogerst, 2012). The Elder Justice Act of 2010, a part of the Patient Protection and Affordable Care Act, has brought attention to this issue, but Congress has not approved any of the funding the act requires.

How does elder mistreatment affect the elderly? The American Academy of Nursing on Policy says, “For the elder, the experience of mistreatment itself, in any of its forms, often also results in behavioral health symptoms including depression, risk of suicide, anxiety, cognitive dysfunction and sleep difficulty; self-treatment with drugs and alcohol; injuries and morbidities resulting in higher use of emergency department, hospital and nursing home services, and greater mortality (Dong, 2014).”

What is being done to combat this growing problem? An Elder Justice Roadmap (Connolly et al., 2014) was created in 2014 with assistance from the Department of Justice and the Department of Health and Human Services. This “Roadmap” is a guide to “strategic policy, practice, education and research initiatives that” advance the goals of the Elder Justice Act. The American Academy of Nursing on Policy draws from this Elder Justice Roadmap that the top priorities for moving forward are “prevention, recognition, and treatment,” as well as “education,” “training,” and “research.”

 

How do I report this?

National reports of abuse & neglect in nursing facilities made to the Long-Term Care Ombudsman went down by the thousands from 2006 to 2013. Sexual abuse reports started to go down in number from 2011 to 2013, but this does not mean that there were less sexual assaults to the elderly. Social scientists believe the current number of yearly reports are “only the tip of the iceberg” (Brosens, De Dondera, De Witte, Dierckx, Verte, 2014).

Every state has different rules and laws governing the requirements of who must report elder abuse, but most states at least require that medical professionals in closest contact with the elder, namely home health aides and physicians, are mandated “to report any suspected abuse or neglect” (Haimowitz, Stefanacci, 2013). These “mandated reporters” must report any negligence that is intentional or unintentional for the protection of vulnerable senior citizens. In several states, “‘any person’ is required to report a suspicion of mistreatment” (Haimowitz, Stefanacci, 2013). This includes physical abuse, emotional abuse, sexual abuse, exploitation (of funds or assets), neglect, or abandonment.

Every state has an appropriate number of a department to call if you suspect elder abuse. You will need to provide the senior’s name, address, contact info, and details of what causes you concern. Be prepared for more questions about the elder’s medical history, family environment, and any signs of abuse. You may also be required to report to the facility you work in if you work for the elder in that capacity. You should report to the facility in any case. You may or may not be able to report anonymously; this also depends on your state. Always be on guard and watching, and always report suspicious activity around the care of an aging adult.

 

From LeAnne Smith, veteran R.N. and ALN Legal Nurse Consultant:

“In the last few years, I have evaluated potential cases which involved allegations of rape or sexual assault. In one case, a 53 year-old female nursing home resident, who was described as cognitively intact and had no history of psychiatric diagnoses, reported an attempted rape. The resident was assessed with no injuries identified, and the MD, family, and police were notified. The resident was transferred to a psychiatric facility for evaluation of delusions and returned to the facility the same day. The state was not notified and there was no investigation of the events on any level. It was simply forgotten.

In another case, an 80-year old female resident had reported inappropriate comments and touching by a male staff member.  This was reported to a facility LPN, who told the resident to complete a “care concern report”. The LPN did not report the events to anyone, and the resident was not assessed for injuries. Two years after these events, the resident reported the events to Adult Protective Services (APS). APS investigated the report, and allegations were substantiated. The alleged perpetrator was fired, and the LPN who failed to investigate and report the events was disciplined for failing to comply with mandatory reporting of alleged abuse. There were other cases which were also handled in a similar manner.

My experience with cases involving rape or sexual assault allegations mirrored the findings in the CNN Investigation. It appears that allegations involving sexual assault or rape are not adequately reported or investigated, leaving the elder population at risk.  Additionally, it appears the medical professions serving the elderly are not adequately trained in the appropriate process for reporting and investigating these types of allegations.”

 

What does the future hold?

The American Academy of Nursing on Policy (AANP) recommends the “expansion of Medicare/Medicaid reimbursement to better cover screening and basic first level mental health services by primary care provider staff.” This will detect mental health issues, substance abuse or misuse, and mistreatment to the elder.

The AANP also recommends that there be inter-professional training to combat and prevent ageist mistreatment, “mandatory continuing education for nurses on elder abuse,” prioritizing of a “research and program evaluation agenda,” disseminating of training materials, and intervening from Adult Protective Services. The AANP believes that the “effectiveness of preventive, early recognition, surveillance, intervention (including legal) and rehabilitative programs… including those with cognitive impairment” can work to end this sad epidemic.

CNN investigations report that this silent phenomenon of elder sexual assault is widespread and some medical and care facilities are “willfully” ignoring its existence. Strides to unveil what’s hiding in the dark, literally and figuratively, are being made, but please read more in our source list to learn how you can be an agent of change for the elderly. Medical professionals have an obligation to watch over, protect, and seek justice for our aging and ailing patients.

 

Sources:

“Sick, Dying and Raped in America’s Nursing Homes.” CNN. Cable News Network, n.d. Web. 08 Mar. 2017.
http://www.cnn.com/interactive/2017/02/health/nursing-home-sex-abuse-investigation/?iid=ob_homepage_deskrecommended_pool

Expert Panel on Aging, and Psychiatric, Mental Health & Substance Abuse Expert Panel. “Elder Justice: Preventing and Intervening in Elder Mistreatment.” Nursing Outlook 63.5 (2015): 610-13. Web.

Bloemen, Elizabeth M., Tony Rosen, Sunday Clark, Denis Nash, and Thelma J. Mielenz. “Trends in Reporting of Abuse and Neglect to Long Term Care Ombudsmen: Data from the National Ombudsman Reporting System from 2006 to 2013.” Geriatric Nursing 36.4 (2015): 281-83. Web.

Donder, Liesbeth De, Nico De Witte, Dorien Brosens, Eva Dierckx, and Dominique Verte. “Learning to Detect and Prevent Elder Abuse: The Need for a Valid Risk Assessment Instrument.” Procedia – Social and Behavioral Sciences 191 (2015): 1483-488. Web.

Dong, Xinqi. “Advancing the Field of Elder Abuse: Future Directions and Policy Implications.” Journal of the American Geriatrics Society (2012): n. pag. Web.

Stefanacci, Richard G., and Daniel Haimowitz. “What We Need to Report and to Whom.” Geriatric Nursing 34.1 (2013): 68-71. Web.