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Sexual Assaults Haunt Families of Elderly
Victims
By Julie Appleby, USA Today
May 26, 2004
Marilyn Keffer's mother, in photo, was among 5 women sexually assaulted by a resident at an Ohio center.
New Philadelphia, Ohio: Kathy Recco's soft blue eyes still tear up when she thinks about what happened at the Alterra Clare Bridge Cottage assisted living center here, where her mom lived.
During a four-month period that began in the fall of 2001, an 84-year-old male resident, who suffered from dementia, sexually and physically assaulted five elderly women at the center, a state health department investigation concluded.
Workers caught him time and time again in the rooms and beds of female residents, sometimes dressed, sometimes not, investigators said. One aide saw him rubbing an elderly woman through her adult diaper; another caught him on top of a resident, her pajamas pushed up around her neck. He was found in one woman's room as she cowered behind a chair, naked.
The women were fearful. One begged an aide to lock her door.
But not one of the employees called the police. The man was not moved out of the 40-bed facility. No one told the women's families or informed their physicians. Employees later told state investigators they were instructed not to note the incidents in a written file -- and not to talk about them.
Recco learned of the assaults in January 2002, when a former employee called her. She was stunned. ''I almost wanted her to stop talking,'' says Recco. ''How can you think that you put your mom in this place and she was maybe being raped?''
She went to the police, prompting the state investigation.
Based on medical records, written statements from employees and interviews with those workers, state investigators determined that the elderly women had been abused by the man and that the center's supervisors had done little to stop it.
''This placed the . . . female residents . . . in a situation of real and present danger,'' the report concluded. The state could not, however, verify reports from some staff members that they were ordered by supervisors not to write down the events.
In a written statement, Alterra Healthcare said it ''does not deny that this resident was displaying inappropriate behavior'' and said its staff is trained to deal with such behavior, although it may not be able to prevent it. Following its own investigation, and that of the local police, Alterra also said, ''We do not have evidence that any sexual intercourse occurred.''
Alterra, one of the nation's largest assisted living chains, paid a $10,000 fine to the state in connection with the allegations.
Residents are vulnerable
The New Philadelphia center experienced many of the challenges a USA TODAY investigation found beset the assisted living industry: high employee turnover, delays taking action when problems arise, frail residents who sometimes can't speak up for themselves and regulations that are less restrictive than those governing nursing homes or hospitals.
The case also illustrates the extraordinary challenges the industry faces in caring for a dependent, elderly population given to confusion and personality changes, often with a shortage of staff and a limited amount of training.
Those challenges can be even greater at facilities like the Alterra center in New Philadelphia that specialize in residents with forms of dementia, including Alzheimer's disease. Some dementia patients become docile, but others become aggressive. They wander. Some may think other residents are their spouses. Sexual aggression is not uncommon.
''Inappropriate sexual behavior of all sorts can be part of the disease, but it's not universal,'' says Sam Gandy, vice chair of the national medical and scientific advisory council of the Alzheimer's Association.
That makes it even more important that facilities that deal with dementia patients have detailed plans on how to care for each resident, along with adequate staffing and training, say experts who work with dementia patients.
Trouble began in 2001
According to state investigators, trouble at Alterra's facility in New Philadelphia began almost immediately after the man was admitted in mid-September 2001. He began wandering into other residents' rooms and taking his clothes off. Eleven days after he arrived, a nurse's aide found him in a woman's bed, according to the state health department's report. The woman demonstrated with two fingers how she said the resident assaulted her. At the time, the facility did not have a top director.
An aide saw the man in another woman's room, feeling her ''pubic area'' through her adult diaper. Weeks later, he was found on top of that same woman, moving ''in a manner indicative of intercourse,'' the report says. Both residents were dressed. Employees witnessed him in the room of another resident, with her pajamas pushed up around her neck. The woman was described as ''wide-eyed and panicked-looking.'' Two female residents were found with blood in their diapers.
Although the facility's supervisors were told by the staff of his behavior, ''There was no evidence that corrective action was taken,'' investigators found. Employees were told to lock the female residents' doors at night.
Three days after Thanksgiving, six staff caregivers went to the new director and told her of their concerns. She began an investigation. The man was sent to a hospital for a psychiatric evaluation. He was readmitted to the center nine days later, in early December.
While the facility's health care coordinator later told state investigators that the facility watched the man more closely after his return from the hospital, staffing was reduced in the two weeks before state investigators swept in in mid-January 2002. Investigators also reported that the man's written care plan, which is supposed to document a resident's special needs and behaviors, was ''totally silent to the resident's aggressive sexual behavior and physical outbursts.''
Policies were not in place informing staff members what to do in case of abuse, investigators said. Three staff members interviewed by investigators said they were unaware of a toll-free complaint hotline operated by the state.
And, illustrating the loopholes that often exist, Ohio law requires assisted living facilities to report abuse problems involving employees. But it does not require them to report resident-on-resident abuse.
The right thing?
Marilyn Keffer, whose 82-year-old mother was allegedly assaulted by the man, says the state's report helped to explain changes she saw in her mom. ''All of a sudden, she just started hating men,'' says Keffer. ''She would throw fits when a man came on TV or when my husband walked in the room.''
Time has not cooled Recco's or Keffer's outrage. Nor has it ended the controversy over what happened at Clare Bridge Cottage, the name Alterra uses for its facilities that specialize in caring for people with dementia, including those with Alzheimer's disease.
The troubles there represent a near-universal fear among families: What if I did the wrong thing by putting Mom or Dad in an assisted living center? Will I know if he or she is being cared for properly?
''Up until those four months, we thought we had done the right thing,'' says the daughter of one woman who was allegedly assaulted. The daughter, who asked that her name not be used, says, ''We feel terrible. We let her down.''
But no one is omniscient, and family members don't always know what's going on inside assisted living facilities, despite regular visits.
Keffer says she visited her mother one day and found the male resident in her mother's bed, sleeping. Her mother was sitting in the room in her wheelchair.
''I had no idea he was doing more than that,'' says Keffer.
Keffer learned of the alleged incidents at the facility when she got a call from the New Philadelphia Police Department, asking her if she was aware that her mother may have been sexually assaulted.
''That's like telling you that your child's been raped,'' she says.
Allegations that assisted living centers cover up problems, injuries or deaths are not uncommon in lawsuits and in state investigations. While it is not just the Alterra chain that has had such complaints, the New Philadelphia center is not the only Alterra facility that has recently faced cover-up allegations:
* In Perinton, N.Y., a grand jury in September indicted assisted living employee Jesus Gonzalez for attempted sexual abuse of a resident while he worked at the Alterra Clare Bridge facility. He was convicted on four criminal charges in February and sentenced to 15 years in prison. The facility agreed to pay a $75,000 fine for failing to report the incident, according to state officials and records.
* In Lower Makefield, Pa., a resident with Alzheimer's was kicked or stomped by an employee at the Alterra Clare Bridge facility, but his injuries and subsequent death were not reported to authorities. Instead, court records show that his death was initially attributed to ''failure to thrive.'' Employee Heidi Tenzer was convicted last November of third-degree murder and sentenced to up to 30 years in prison. She is appealing the conviction. The facility was never charged, but it closed in November. Administrator Anne McClintock, nurse Patricia Policino and aide Julia Pearson pleaded guilty in September to several charges, including failing to report the resident's injuries to state or local officials. They each received probation.
Until the problems with the male resident were uncovered, the Alterra facility in New Philadelphia enjoyed a fairly clean record.
''It was not a high-incident home,'' says regional ombudsman Rhonda Clark. Every state has an ombudsman program that investigates complaints and advocates for residents of nursing homes and assisted living centers.
A chilling report
Alerted by the New Philadelphia chief of police of what Recco learned, state health department investigators showed up unannounced at the Alterra facility on Jan. 22, 2002. Two months later, they issued results of their investigation in chilling detail.
After the state report was issued, Alterra Healthcare agreed to a $10,000 fine, days before a public hearing to determine whether its license for that facility should be pulled. Families had hoped the hearing, which was canceled after the fine was agreed to, would shed light on what happened -- and why they weren't informed.
''If they had just said after the first time, 'Something happened here. We feel horrible about it. And we apologize,' that would have been it for us,'' says the daughter who asked for anonymity. ''But to let it keep happening and not do anything about it, that's what upset us.''
Four families, including hers, filed lawsuits. Alterra has denied the allegations in them. The cases were essentially on hold during most of 2003, as Alterra filed for Chapter 11 bankruptcy-court protection. Under terms of the bankruptcy reorganization plan, lawsuits against Alterra were to go to mediation; many of the cases are scheduled for this summer. Alterra emerged from bankruptcy-court protection in December. The facility in New Philadelphia remains open.
The male resident involved in the cases -- a retired steel plant foreman -- has since died. So have three of the women.
''I don't believe he sexually assaulted anybody,'' says the man's attorney, Jim Hofelich of Cleveland. ''There is nothing in his background that would indicate that he would do something like this.''
Like many aging spouses faced with an increasingly confused partner, the man's wife moved him to the assisted living facility when she became unable to care for him.
''His wife is suffering greatly over these allegations,'' says Hofelich, who says there may not have been an attacker in the facility at all. ''I haven't seen the proof. Depending on who you talk to, nothing may have happened.''
Just as the man's family can't escape the allegations, neither can the families of the women.
''Mom was such a modest woman,'' says one daughter. ''When you read what he did to her, it broke our hearts.'' Her mother has since died.
Kathy Recco's mom was not one of the women the state says were assaulted. But Recco is still tortured by the thought that her mother might have been attacked and no one noted it. ''I was paying them to take care of her,'' says Recco, whose mother is now in a nursing home. ''When I walked in, they were all smiling and telling me my mom was fine. Yet all along, women were being abused. I believed them and went home.''
All three of the daughters say they want changes made to state law that would require additional staffing at assisted living centers, particularly those that care for people with Alzheimer's. They also want tougher rules about reporting problems to families and to adult-protective agencies.
''There has to be a way to keep better track,'' says Keffer.
No criminal charges
Concern over the state's report resulted in an investigation by city prosecutors for possible criminal charges against supervisors or employees. None were brought.
Francis Forchione, city prosecutor in nearby Canton, picked up the investigation after the New Philadelphia prosecutor withdrew because his own mother lived at the facility. Forchione interviewed four employees and reviewed the state health report. He was not asked to investigate whether Alterra corporate officials were aware of the problems in New Philadelphia.
In April 2003, he made his conclusions known in a letter to the New Philadelphia prosecutor. The health department, Forchione wrote, had sufficient evidence that Alterra failed to provide adequate staff and failed to notify families. Credible evidence existed, he said, indicating that Alterra supervisors threatened employees with the loss of their jobs if they disclosed the sexual abuse.
But he did not have enough evidence to bring charges of gross neglect against any employees under Ohio law.
Forchione told USA TODAY that he had wanted to charge at least one of the facility's supervisors, but his main witness -- a staff aide -- became reluctant to testify.
''She was the one who really had the most one-on-one interaction with the supervisor,'' Forchione said. Her trouble remembering ''creates an obstacle that hinders these claims from being pursued . . . other incriminating evidence would be based on hearsay and would not be admissible,'' his letter to the New
Philadelphia prosecutor says.
In conclusion, Forchione wrote that the Alterra facility appears to be an ''outstanding facility.'' After meeting with current and former Alterra employees, he wrote that ''we are amazed at their dedication and devotion to the residents.''
Recco was stunned by the $10,000 state fine, which she felt was too light, and by Forchione's decision not to bring criminal charges and to praise the facility's employees.
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'If they cared so much, why didn't a single one of them -- past or present employees -- come forward to report the abuse?'' she says.
''If I had not gone to the police, they would have gotten away with this. They almost did.''
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