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Elder abuse often treated as personnel issue instead of crime

If you saw someone punch a disabled person with a closed fist on a street corner, most people would call the police. But when it happens behind the closed door of a nursing home, the response tends to be less clear-cut.

At least that’s what staff attorneys from Disability Rights California found in a report issued this week that explores 12 cases of abuse against elderly or disabled people in California nursing homes. The nonprofit advocacy group's report is called "Victimized Twice: Abuse of of nursing home residents, No criminal accountability for perpatrators."

Although nursing home employees are bound by “mandated reporter” laws that require them to immediately report abuse to authorities, that does not always happen.

Abuse tends to be most efficiently reported to the Department of Public Health, which licenses nursing homes, the report shows. It also tends to get to elder care ombudsmen, who are valid recipients of reports that caretakers are obligated to share.

But care workers are far less frequently calling criminal investigators, the report finds. And that's key, the report suggests, since an ombudsman who does not get consent from a victim to go forward with an investigation is left with no legal option but to drop the matter.

The report's authors interviewed the state attorney general’s elder abuse specialists, who said that they provide a mandatory training video to nursing homes on employees’ duty to report abuse to authorities immediately, but:

“Facility administrators will instruct them to the contrary. The facility administrator makes the determination about whether an incident is reportable. So reports made are siphoned through the facility filter.”

It instills a culture of responding to abuse as administrative concerns rather than serious criminal matters.

Pamila Lew, a staff attorney and author of the report, said while examining the 12 cases detailed in the report, she saw that some startling cases got little or no law enforcement attention.

“When you’re in a facility, the life of a facility is its own internal world,” Lew said. “In a facility’s culture, it can become known that you can get away with a lot of things.”

The report criticizes the tendency of some nursing homes to investigate claims of abuse internally before reporting them to an outside authority such as the elder care ombudsman, law enforcement or the attorney general’s office. By then, it’s too late to collect evidence or build a solid case that can be proven in court. And, in some cases, the report says:

The internal investigation process means that some incidents may not be reported to outside entities, depending on the outcome of the internal investigation. As described by one ombudsman, “The supervisor investigates and decides it didn’t happen.”

All said, Leslie Morrison, an attorney and director of the Disability Rights investigations unit, does not believe the report calls for any new laws or regualtions. She said the laws on the books are strong, but there is insufficient statewide leadership to ensure that the laws are strictly followed.

"Yes, the system is seemingly in place, but there are gaps and lapses at every step of the way," Morrison said.

The report includes vignettes about several cases that its authors culled from citations issued by the Department of Public Health. One illustrates the points they make about abuse that is never exposed to outside scrutiny. The case was analyzed for the nonprofit advocacy group by Dr. Diana Koin, a physician who specializes in geriatrics and serves as an expert on elder abuse.

Luis Aguilar is a 41-year-old man with multiple physical disabilities, including head trauma and associated memory problems. Late one night, a staff member noticed blood on his mouth and a cut to his upper lip. She asked him what had happened. Luis answered that a male CNA had hit him with a closed fist and then slapped him on the face.

The facility launched its own investigation but failed to photograph the injury and only conducted a cursory physical assessment. According to Dr. Koin, Disability Rights California’s medical expert, “When people are hit, the mouth is injured internally from contact with the teeth. If a person is struck, then not only does the external lip show some evidence of injury, but the tissue, the mucosa inside the lip shows damage. The facility incident report states clearly that there was a cut with discoloration at the affected site.”

Two days later, the facility administrator notified the ombudsman but did not call law enforcement even though Luis’ description of the event qualified as an assault. The facility doctor evaluated Luis five days later and found no evidence of injury, not surprising given the time delay.

Ultimately, the facility concluded that the injury was a result of chapped lips or poor oral hygiene, both of which, according to Dr. Koin, indicate resident neglect if true. Dr. Koin disputes this conclusion, finding the description of the injury in the incident report is consistent with a blow to the mouth, not chapped lips.


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csmith60's picture
Great article- even more reason for the California long term care ombudsman program to be funded adequately to ensure more eyes and ears in nursing facilities. A truly cost-effective strategy to help hold facilities accountable and improve patient/resident treatment.
nyefrank's picture
Riverside County a violent a attack on a elder man and his wife. Nye Frank 68 zero history of involvement in crime, and his wife 72 year old Lee Frank no crime history. Celebrating a new home Nye built as a gift to Lee took a brake to go get the newspaper at the rural country road corner. A young angry man 27 Ty A Reddish professionally trained in judo and wrestling attacked Nye like the guys on tv wrestling. It was a brutal attack infront of Lee Frank. She begged the guy to stop but he would not. Lee got into her car as there was not anyone to assist her and thought perhaps if she drove it close to Nye Frank he may be able to get into it. Ty released Nye when he saw the car but had already been choking him and strangling Nye for a long time and bouncing on his chest. Nye did come to and able to get into the car to go home for lee to put on a clean shirt and go to the hospital. Lee's daughter saw the car go up the drive way and wanted to know what they wanted moved next. The new house and the old one directly across the street can see the front yards from either house. Calling for her mom she walked into her parents bedroom and on the floor dead was Nye Frank. Lee had one arm in her shirt when she came from her dressing room. There was strangulatin and broken chest bones. That night the parents of the 27 year old stalked Lee Frank and her family and harrassed the neighbors by them verbal attacks and non stop phone calls. The next morning Ty Reddish was let out of jail. The sheriff said he was not investigating because the prosecutor said they were not filing charges. The sheriff and Da obstructing getting the reports but with the help of NOVA the reports were received. The homicide closed by 104a a federal ruling without a hearing and without evidence. The victim compensation denied without evidence. The killer and his family were allowed with officials knowledge to stalk Lee, her family and neighbors. The court records of Ty Reddish probation removed and with the DA knowledge. No resitution, no hearing was allowed. Lee has applied in Federal court in Los Angeles. The attorney representing the DA and Supervisors, and sheriff is the same agency representing the killer. The audio at the time the sheriff reached the location the father states that the campaine manager for the DA Rod Pacheco told him how to get out of this and what to say. Not in police report. The internal affairs department after discovery with a FOIA said they could no longer talk to Lee or anyone about the case. The 104A enables the official to keep all records secret and a news black out. The crime was not given a crime case number which blocked Lee Frank from access to the courts. We have filed in Federal Court but the DA Rod Pacheco is fighting it. Lots of exparte meetings with the federal judge and the da attorney. There has been threats to Lee to lose every thing she has if she continues this. Looking at title records and evidence from other victims it shows parties at the site when prosecutor first got to the crime scene and Phil Reddish statements that there is a probate judge who originally transfered the property to the Reddish family alledged to be illegally. The federal employee family member of the judge Jo Taylor and her husband. The Reddish family and the Taylors are in several probate lawsuits. We had several elders call us to state they also were not given crime case numbers. The first UN case from the united states is from elders here in the inland empire. The AG says he has discretion to investigate. Even though Federally Funded programs and mandated benifits were denied Lee Frank. Leota Frank Riverside County Superior Court. 310 619-6260. If you have any ideas for help we would appreciate it. Both state and Federal judges have denied protection orders

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