March 7, 2002 -- Helen Love, a 75-year-old grandmother of three, looked into the video camera and told of being severely beaten by a nursing home caregiver who discovered she had soiled herself.
"He choked me and he went and broke my neck," said Love, who had to wear a metal halo in the videotaped deposition from July 1998. "He broke my wrist bones, in my hand. He put his hand over my mouth."
Two days later, Love died.
Nursing home officials did not report her beating to a state official who was at the nursing home at the time. Ultimately, though, Love's attacker served a year in prison. An investigation revealed that he had been fired by two previous nursing homes for aggressive behavior.
On Monday, the Senate Select Committee on Aging saw Love's deposition and got the results of a General Accounting Office report on elder abuse. An 18-month review of three states with high nursing home populations suggested that cases like Love's may be more common. The report found that many nursing home abuse cases are not immediately reported to law enforcement officials.
Anatomy of Abuse Neglect
The GAO report found that 50 percent of abuse reports from nursing homes came at least two or more days after caregivers first learned about allegations. The delay hampered gathering evidence and made prosecuting the cases difficult.
But some experts suggest the problem could be worse.
"The biggest problem is that these people are hidden. There is very little traffic going into these [nursing] homes from relatives of these victims or people who could observe what's going on," said Sara Aravanis, director of the National Center on Elder Abuse.
A 1996 report by the National Center on Elder Abuse estimated that unreported cases of elder abuse outnumber reported cases by a ratio of 5-to-1. According to the Senate Special Committee on Aging, which held a hearing into the issue Monday, more nursing homes are being cited for abuse. From 1999 to 2000, the number of cases rose as much as 20 percent.
Experts and the GAO suggested that elder abuse cases may not get reported because relatives or nursing home officials question a person's mental state or because family members fear retribution. Plus, bruising and other skin discoloring that come from abuse may be excused as a natural condition associated with aging.
"I would say any change in behavior should be considered a sign," said Aravanis. "If a normally outgoing person suddenly becomes withdrawn or someone suddenly becomes very agitated, that's a sign of abuse."
Holes in Background Checks and Registries
In its report, the GAO focused on three states with large nursing home populations — Georgia, Illinois and Pennsylvania. The GAO report found that in the 158 cases reviewed, 26 nursing homes were cited for abuse-related deficiencies. One home was fined, while other 25 homes faced lesser sanctions such as developing corrective plans to prevent future abuse.
The three states the GAO reviewed required criminal background checks on potential nursing home employees. But not all employees, such as maintenance workers, are required to undergo background checks, and many are allowed to start working before their investigation is completed. In addition, background checks are often limited to an employee's record in one state alone.
State survey agencies have also set up nurse aide registries for caregivers previously cited for abuse. But inconsistent registry updates, GAO investigators found, nullified their effectiveness.
"As the nursing home population grows, I fear incidents like these will grow more common unless we do more to ensure the quality of care for residents," said Sen. John Breaux, Louisiana Democrat and chairman of the aging committee. "We need to better train law enforcement officials to address nursing home abuse, urge states to mandate all nursing home deaths go through the coroner's office and implement other mechanisms to stop this disturbing trend."
Is Better Policing Enough?
While the American Health Care Association agreed that improvements could be made in how abuse cases are handled, it worried that the GAO was suggesting that nursing homes are not generally safe for the elderly.
Nationwide statistics show that slightly more than 2 percent of the approximately 17,000 nursing home facilities nationwide were cited for actual abuse of patients, according to the association. More often the facilities are penalized for procedural violations.
"Suggestions that abuse is significantly higher than 2 percent, as depicted in the GAO report, includes citations concerning policies and procedural issues," said Charles Roadman, president and CEO of the AHCA.
Roadman argued that quality of care is often linked to the number of staff hired to look after nursing home residents and he called on federal officials to set an "optimal staffing standard" for nursing homes.
Still, advocates say better trained police and more nurses will not solve the problem alone. Better-trained and continually trained staff may be the key.
"There must be more precise and universals guidelines set for what is proper care and what isn't," said Aravanis. "We have to train people on what is abuse and what is not. We have to have more background checks and then psychological profiles to see whether some of these people can handle caring for people who need intensive care. And it can't be a one-shot deal … the training has to be ongoing."