Chicago Nursing Home Abuse Attorney Blog

How widespread is senior abuse? The National Institute of Justice, reported in May that about 11 percent of people ages 60 and older suffer from some kind of abuse every year. That's more than one in ten. The biggest category that people contacted by NIJ said they suffered in the last year was emotional abuse (5.1 percent), with 1.6 percent suffering physical mistreatment. Financial exploitation by a family member was reported by 5.2 percent of those contacted. Financial exploitation of seniors reportedly costs more than $2½ billion a year.

And the consequences? The chances of dying go up. Other studies say elderly victims of abuse, neglect and exploitation have twice the risk of dying of those who aren't victims.

There are many stories that point out the extent of the problem: cases of home aides giving lethal doses of drugs and of people using positions of trust to permanently "borrow" money from seniors,

All of this would seem to make enhancing the rights of the elderly an obvious choice for legislators - particularly since the number of people over 55 is the most rapidly growing demographic and seniors vote in larger numbers than other age groups.

But there are opponents to the legislation. They talk about skyrocketing federal spending, state's rights and creating more government bureaucracy. Some question provisions designed to check the backgrounds of people hired to be involved with older citizens, since most abusers are known to their victims.

Backers of the Senate's Elder Justice Act and similar House proposals are now linking the cause to healthcare reform. They say this makes sense because elder abuse increases healthcare costs and financial exploitation leaves many victims to rely on public aid. Prevention would therefore be good policy, saving money in the long run.

"This is prevention, which is a healthcare issue," Robert Blancato, who heads the Elder Justice Coalition, an umbrella group for more than 500 groups that support the legislation, told Kaiser. Coalition members include AARP, the American Bar Association and industry groups representing nursing homes and long-term providers.

And why should the federal government get involved? Because studies show state and local licensing agencies. long-term-care ombudsmen and adult protective service workers don't have the resources to handle the problems.

Researchers at Texas A&M University, in a report to the U.S. Justice Department, concluded that "the universal lack of resources, the enormous variation across jurisdictions and the low priority given to elder abuse and neglect make it difficult to see how significant progress can be made without federal standards and financial support."

The current healthcare bills would require states to conduct comprehensive screening of people working with the elderly. This includes those doing home-based care, an group which almost one-quarter of the states don't regulate at all. Additional states only do background checks on medical workers. The bills would also set criteria for hiring - and firing - persons who have committed or commit violent crimes, including an appeals process.

Michael Kosner, President
The Kosner Firm Chtd.

We hear about child abuse and wife beating more than we hear about senior abuse. They're all ugly concepts, but we are likely less aware of the elderly being mistreated since what we hear is generally limited to nursing home cases. This is a limitation that is being relaxed as both houses of Congress debate elder justice provisions in connection with health care reform.

Nursing homes provide the public face since, as Marsha Greenfield of the American Association of Homes & Services for the Aging recently said in an article written by Kaiser Health News, seniors are a more invisible population.

"Adult abuse is a lot harder (than abuse of other vulnerable populations) to get your arms around," she told Kaiser, an independent health news service. She added that this is because, while there are a growing number in community and group living arrangements, so many of the elderly are in their own homes.

The article added that other populations have become more visible as celebrities speak out on their problems. It noted that Nicole Kidman recently spoke at a congressional hearing on violence against women and that stars of "Law & Order: Special Victims Unit" appeared at a Washington rally about child abuse.

Meanwhile, a coalition of elder abuse groups could only muster ordinary seniors telling their painful stories of physical and emotional abuse and financial exploitation. It's too bad that fewer people - and publications - take time to listen when a celebrity isn't speaking.

The lack of support that comes with a lack of spotlight may be changing as federal lawmakers consider establishing federal law to support the fight against elder abuse.

The House's healthcare bill would provide for national background checks for people who care for the elderly. This would override a mixture of state laws that have let known offenders end up in positions of trust where they can do additional harm.

The Senate is considering a broader Elder Justice Act that would provide federal dollars to identify and investigate elder abuse locally, require long-term care providers to report possible crimes to federal authorities and create new oversight within the Department of Health and Human Services. These provisions have been approved by the Senate Finance Committee and are part of health legislation headed for floor debate.

These provisions would help, but only up to a point since studies show up to 90 percent of elder abuse cases involve family or trusted advisors and happen in private homes. And this will get harder to control as more elderly people are at home or in community and group living arrangements without the kinds of oversight mechanisms available when, for example, child abuse is suspected. There, professionals (teachers, doctors, etc.) outside the home are required to report suspected abuse to authorities.

We'll see how the legislation develops. After all, money, as with all things, remains an issue. The Senate Act has an estimated cost of $757 million over four years. Even though this is negligible compared to the cost of healthcare reform as a whole, and despite broad support that includes more than 500 advocacy groups, this could mean passage problems.

For more information on the legislation, click here or here.

Michael Kosner, President
The Kosner Firm Chtd.

A public meeting earlier this week took a hard look at the practice of putting younger adults with mental illnesses in Illinois nursing homes. Members of Gov. Pat Quinn's Nursing Home Task Force spent four hours listening to social workers, nursing home residents and advocates demanding that the practice stop. These undesirable residents allegedly include felons who police say assaulted, raped and even killed elderly and disabled housemates.

"A nursing home is not the place to test the rehabilitation of violent offenders. It is not the place to see if the fox can live peacefully in the henhouse," said Jamie Jimenez, an advocate with the Community Counseling Centers of Chicago, quoted in an article in the Chicago Tribune.
As well they should be, the governor's representatives were also upset by the violence in the state's facilities. "We have a situation that is not acceptable to us," said task force chairman Michael Gelder, Quinn's senior health policy adviser. He described the hearing as "a call for action," that call coming in the form of questions about, and criticism of, Illinois' long-term pattern of putting criminals with mental illness with the elderly and disabled. The shuffling of younger residents into nursing homes from jails, shelters and psychiatric facilities has put a definite strain on that industry and fails both the psychaitric patients and other nursing home patients.

"We are in crisis now," said Phyllis Mitzen, co-director of the Center for Long-Term Care Reform. "We find ourselves ... with a need to change the entire long-term care system."

Mark Heyrman, a board member of Mental Health America of Illinois, noted that psychiatric patients often receive substandard treatment in nursing homes and could be more cheaply and effectively housed in community mental health centers and assisted living arrangements. "Our long-term plan has to be to stop institutionalizing people in nursing homes who are only there because of a mental illness," he said.

The Tribune says Illinois nursing homes currently house about 15,000 people whose primary diagnosis is a mental illness, and one speaker estimated two-thirds of them could be in less institutional settings within five years if the state budgets for community rather than institutional care. Anthony Zipple of Thresholds mental health centers said Illinois has two pilot programs, though small ones "relative to need," that seek to move hundreds of mentally ill people out of nursing homes.

State law requires criminal background checks (and assessments of risk to other residents if felonies are found) of all incoming nursing home residents. However, a Tribune investigation said those screenings were inaccurate and often took longer than a year.

Other speakers called the current process farcical, and noted that nursing homes don't always report crimes that take place to the police. Moreover, police reports are generally not shared with state inspectors. They called for closer cooperation between the state and local law enforcement and prompt removal of licenses from homes with continuing patient-safety issues.

The task force will hold its next meeting next week (Oct. 29) in Springfield. We can only hope the state moves quickly to correct the kinds of conditions that led another speaker at last week's meeting to report he had been stabbed by the same person in two different nursing homes. In the meantime, be ready to question a home's policies in this area (Who do you let in?). It can keep your loved ones safer.

And if you have comments or recommendations, check out the task force's web site.

Michael Kosner, President
The Kosner Firm Chtd.

I've written about negligence as someone doing something unreasonable. While neglect may be planned, in practice it is often a failure to do something. Abuse, on the other hand, generally involves someone acting to hurt someone else. It's a broader area than neglect and some kinds of neglect fall within its definition.

Abuse is when someone harms someone else. This damage can be physical or emotional. Nursing homes have become centers of abuse because the people entrusted to them cannot defend themselves and the homes may not be able to control underpaid and uncaring employees.

How many of us can relate stories like that of the man, suffering early Alzheimer's, whose wife resolves that, though he is in a nursing home, she will do everything she can to preserve his dignity. She provides him with nice clothes and makes sure he has pictures of his kids and a few dollars in his pocket, only to find that everything with any potential value disappears within days, if not hours. Theft is rampant and, in the end, all she can do is bring him clothes from the Salvation Army Thrift Store and try to control her frustration and indignation.

Then there are stories of sympathetic nurses or aides who warn relatives of persons entering a nursing home or a hospital to take home anything they have of value because otherwise it will surely disappear.

We even know of a computer whiz who, after finding that his mother's belongings were gone from her nursing home room, rigged hidden cameras and caught the culprits - or at least some of them.

Illinois, as well as the other 49 states, have enacted laws that make elder abuse felonies; they make physical abuse and financial exploitation crimes.

Physical abuse may include beatings, sexual attacks and being forced to swallow food or medicine. Here is where neglect can fall in, when a caretaker who doesn't care fails to feed or dress patients, or to keep them clean.

Mental abuse may occur when someone humiliates, insults or threatens patients, or denies them the dignity of making even simple personal choices, such as whether to get out of bed or when and what to eat.

Financial abuse can be theft of belongings or forcing patients to turn over funds or include someone in their wills.

Why is there nursing home abuse? Understaffing and using under-qualified and poorly paid employees, high-pressure work environments and a lack of proper training have all been blamed. Provisions in the federal Nursing Home Reform Act lay out expectations and requirements for every home that receives federal funds; these facilities are monitored by Medicare as well as state agencies.

Regulators, however, can only do so much, as evidenced by nursing home ratings that drop from above average to dangerously below average from one annual inspection to the next. Inspectors need the support of family members who are looking after a loved one, and family members may have to turn to an attorney to sort through the complications and make sure the law is enforced.

Staying alert may be difficult, but successfully fighting nursing home abuse can at least provide some satisfaction in caring for a loved one - which is, at best, difficult.

Michael Kosner, President
The Kosner Firm Chtd.