Thinking about the unthinkable: staff sexual abuse of residents; Although few staff members ever cross the line, those who do grab headlines, cost facilities millions, and destroy seniors' golden years

Nursing Homes, June, 2005 by Douglas J. Edwards

Staff sexual abuse of residents is a topic you don't hear much about--except when it happens. Such allegations are fodder for local TV news stories and newspaper headlines, and often all nursing homes end up being viewed with an outraged glare. The cases are indeed disturbing; for example, 23-year-old Michael Scott Simons, a former Corvallis, Oregon, Alzheimer's care facility worker, admitted to police that he had fondled the breasts and genitals of three patients, along with having oral sex and sexual intercourse with one woman. (1) Such incidents in nursing homes and other LTC facilities are, thankfully, uncommon, but when staff members sexually assault residents, lives are destroyed, facilities' reputations go out the window, and costly lawsuits are certain.

Managers of LTC facilities should not feel that this is a problem they alone face. "Historically, virtually all institutional environments had incidents of sexual abuse," says David A. D'Amora, MS, LPC, CFC, director of the Center for the Treatment of Problem Sexual Behavior in Middletown, Connecticut, and a board member of the Association for the Treatment of Sexual Abusers. D'Amora explains that institutional settings ranging from psychiatric institutions to group homes for those with mental retardation share characteristics that can increase the possibility of sexual abuse:

* a highly vulnerable population whose members often lack the ability to give consent or defend themselves

* a homogenization or "facelessness" of the population receiving care

* patient needs that require close contact with caregivers (e.g., toileting and bathing)

Although an abuser's behavior might be limited only to one institutional setting, D'Amora says that an abuser often is found to have exhibited similar behavior in other such settings.

Not all sexual abusers have the same motivation, either. D'Amora points out that many of the incidents in institutional settings are acts of molestation, such as inappropriate touching or fondling, which are not done, he says, with a threat of violence or physical hurt: "They are not thinking of the victims or of hurting them," he explains. "Molestation is a selfish way of getting one's own needs met, and there often isn't an intent to hurt. It's not an issue of being cruel. It's just really inappropriate, bad behavior that is ultimately hurtful." Abusers rationalize that victims wouldn't understand what was going on or would be unable to notify someone of what happened because of their cognitive state.

But some abusers truly do intend to hurt their victims, and they are fascinated by the power they have to do this. The sexual component becomes secondary, notes D'Amora; it becomes a way of showing power and control (as with the motives behind rape). In fact, D'Amora says the power dynamic behind sexual abuse in institutions is similar to the one behind some U.S. soldiers' infamous sexual humiliation of prisoners in Iraq's Abu Ghraib prison.

Of course, preventing sexual abuse in the first place is the goal. Genevieve Gipson, RN, MEd, RNC, director of the National Network of Career Nursing Assistants (www.cna-network.org), believes a comprehensive approach can help administrators stop most sexual abuse before it happens. Start with criminal background checks of prospective employees, Gipson advises: "A person who has been convicted of sexual abuse should not be hired in a nursing home."

"Done right," says Stefan Keller, president of Certiphi Screening, "background checks can be extremely effective in helping to prevent the hiring of an individual with a history of sexually abusing patients. Since the best predictor of future behavior is past behavior, individuals with histories of sexual abuse pose a definite risk to long-term care facilities. There are countless stories in the media of healthcare employees who commit criminal misconduct on the job, and then are found, through a background check run after the fact, to have convictions for similar crimes in their history." Keller suggests that a basic background check program include the following:

* identity verification (e.g., Social Security number verification)

* countywide (e.g., at the county court-house) or statewide criminal checks (e.g., at state repositories, including state police)

* employment verification

* education verification

* professional license/credential verification, if applicable

* sex offender registry checks (e.g., through state repositories)

* child or elder abuse registry checks (e.g., through state repositories that collect such information)

* nurse aide abuse registry checks

* checks of additional healthcare databases of "sanctioned" individuals, including the U.S. Department of Health and Human Services' Office of Inspector General (OIG) List of Excluded Individuals/Entities (http://exclusions.oig.hhs.gov/search.html), as well as the National Practitioner Data Bank and the Healthcare Integrity and Protection Data Bank (www.npdb-hipdb.com)

* drug screening

Keller notes that "It's imperative to consistently run the same level of checks on all employees, consistent with the duties that employees will be performing. This practice not only protects the legality of a facility's background check process, but also may reveal individuals with past problems in one type of job who are applying for another type of job. For instance, a nurse aide with a history of abuse may apply for a job at a long-term care facility as an office manager or food service worker."