By Arthur Buchanan
Workers at Claywest House said they had warned their supervisors that Karl Willard, an aide at the St. Charles, Mo., nursing home, tormented elderly residents.
But the 180-bed nursing home was shorthanded and Willard stayed on the job.
Not long after that warning two years ago, one of Willard's patients died of a head injury. A grand jury indicted Willard and in February, he pleaded no contest to first-degree elder abuse for the death of Marshall Rhodes, 78.
In lawsuits filed after Rhodes' death, his family and others alleged Claywest House didn't have sufficient staff.
Rhodes ' family settled for an undisclosed amount. In March, Claywest and its management company, American Healthcare Management, settled six other lawsuits alleging mistreatment for nearly $2.5 million. The home and management company admitted no wrongdoing.
Charles Kaiser, president of American Healthcare Management, said that the home has sometimes had problems finding workers but that it today is a good facility in good standing and "humming along just fine."
Staffing problems are not unusual in nursing homes, according to a recent study by the Institute of Medicine, a national research group. At a time when people 85 years of age and older are the fastest growing segment of the U.S. population, there is a critical nationwide shortage of health-care workers.
In Kansas, Connie Hubbell, the state's secretary of the Department of Aging, said staff shortages and high turnover rates at nursing homes also are a problem. So far, Hubbell said, homes have been able to meet minimum staffing needs without an upsurge in complaints.
But that's not the case in Missouri, where staffing problems contributed to a 21 percent increase in the total number of complaints against nursing homes in 1998 and 1999 combined, the latest years for which data are available.
Richard Dunn, director of the state's Division of Aging, said staff shortages are threatening the quality of care for America 's old and infirm. Dunn's advice for nursing homes: "Don't admit them (patients) if you can't take care of them. We can't justify poor quality care because of staff shortages."
What's more, homes desperate to find staff sometimes are not doing enough to screen out potentially dangerous workers, according to the national study and Missouri auditors.
Legislators in the Missouri House recently passed a bill to prevent nursing homes from hiring people listed as unfit to work with children or the mentally ill. The bill is pending in the state Senate, where it failed last year.
The bill would allow inspectors with the state's Division of Aging to act more quickly to fine or close problem nursing homes. It also would increase the maximum fine for a serious violation from $10,000 to $25,000.
"Hit them in their pocketbook," said Rep. Craig Hosmer, a Springfield Democrat who sponsored the bill. "They're raking in money but it's not going to workers."
Homes would pay more to attract good staff, Hosmer said, if they had to choose between that and paying big fines.
But Earl E. Carlson Jr., director of the Missouri Health Care Association, said fines only divert money needed to fix problems. The association lobbies for nursing homes.
Carlson said state inspectors should closely monitor bad homes and put less pressure on good ones. Nursing homes have only an 80 percent occupancy rate in the state, and patients in closed homes can go elsewhere, he argued.
Missouri nursing homes generally provide good basic care, Carlson added, but often can't meet expectations for more.
"We should be able to do that," he said. "We're not."
Advocates of legislation pending in Missouri say there is a special urgency to fixing staffing and other problems in nursing homes. Within the next five years, the number of Missouri residents 60 years of age and older will increase from 950,000 to 2 million, Dunn said.
And the first wave of the baby boomer generation will turn 65 in 2011.
As more people get older, more nursing home problems are ending up in court. And because of more lawsuits, liability insurance costs for Missouri homes increased 500 percent or more in the past year, Carlson said.
In lawsuits involving Claywest House, families of six former patients contended that staff shortages led to poor, negligent or abusive care. Among the allegations:
Failure to feed or give water to a resident who later died.
Locking away the cane of a resident who later suffered a broken hip and died from complications.
Allowing ants to infest a resident.
Kaiser, president of American Healthcare Management, said the lawsuits amount to only allegations. The home and the management company admitted no wrongdoing in the settlements.
Kaiser said that nursing homes throughout the country need 300,000 nursing aides and that they are hard to find. Claywest even hired people from a Salvation Army shelter, which he said helped the nursing home and the poor.
"That facility (Claywest) deserves an award," Kaiser said.
Kaiser said the lawsuits result from what he called an attorney feeding frenzy that only drives up insurance costs and compounds the problems of caring for the elderly.
Tim Dollar, one of Kansas City lawyers who represented the families, disagreed. "There can't be a lawyer feeding frenzy," Dollar said, "without food in the water."
Jim Bartimus, an attorney who works with Dollar, said such lawsuits force homes to make improvements. If they don't provide good care up front, Bartimus said, lawyers will make them pay more in the end.
Among the plaintiffs in the lawsuits filed against Claywest was Bonnie Thorpe of St. Peters, Mo. Thorpe said she often visited her mother, Edythe Beck, and helped care for her.
But Thorpe had to leave the state on a short trip in May 1999. Then her mother died. A doctor said the cause of death was starvation, dehydration, pneumonia and infection.
Thorpe said that her 74-year-old mother, like many advanced Alzheimer's patients, had to be coaxed to eat and drink. Thorpe said she fed her before leaving on May 16, 1999.According to court records, she later discovered that no one else fed her mother for five days, at which point she died.
Kaiser said patients with advanced Alzheimer's often refuse to eat and die of starvation. He said state law does not allow workers to force feed them.
Another plaintiff, Robert Jones of St. Charles, said his 84-year-old mother needed a cane and her glasses to walk when he put her in the home in August 1999.
Jones said he visited days later and found her cane locked in a nursing cabinet and her glasses in another patient's room. She didn't have them again two days later, he said, when she fell and broke her hip.
When called to the home, Jones said, "I picked her up and put her in a chair and wheeled her to the car and a hospital myself."
According to court papers, she died of complications from the fall on Aug. 25, 1999 -- 23 days after she entered Claywest.
In another case, an 86-year-old woman allegedly left lying in her own waste was found covered with ants. The lawsuit contends that family members picked ants off her days later as she died of natural causes.
Most of the incidents alleged in the lawsuits occurred in 1999. At that time, the state had cited the home for staff shortages and other problems. It was operating on a temporary license.
The Division of Aging proposed more than $360,000 in fines over two years. That ended last fall with a settlement for $128,000 -- the largest such fine ever collected in Missouri.
Today, Claywest is open and in good standing again with the state.
But Thorpe said nursing homes that cannot provide enough staff should not admit patients. Her mother's care, and subsequent death, have left her afraid of her own so-called golden years.
"Anyone of us could end up in that boat," Thorpe said.
Elder Abuse Is a Serious Problem
Each year hundreds of thousands of older persons are abused, neglected and exploited by family members and others. Many victims are people who are older, frail, and vulnerable and cannot help themselves and depend on others to meet their most basic needs.
Legislatures in all 50 states have passed some form of elder abuse prevention laws. Laws and definitions of terms vary considerably from one state to another, but all states have set up reporting systems. Generally, adult protective services (APS) agencies receive and investigate reports of suspected elder abuse.
The 1998 National Elder Abuse Incidence Study funded in part by AoA found the following:
551,011 persons, aged 60 and over, experienced abuse, neglect, and/or self-neglect in a one-year period;
Almost four times as many new incidents of abuse, neglect, and/or self-neglect were not reported as those that were reported to and substantiated by adult protective services agencies;
Persons, aged 80 years and older, suffered abuse and neglect two to three times their proportion of the older population; and
Among known perpetrators of abuse and neglect, the perpetrator was a family member in 90 percent of cases. Two-thirds of the perpetrators were adult children or spouses.
Generally Accepted Definitions
Elder abuse is an umbrella term used to describe one or more of the following:
"Physical abuse is the willful infliction of physical pain or injury, e.g., slapping, bruising, sexually molesting, or restraining.
"Sexual abuse is the infliction of non-consensual sexual contact of any kind.
"Emotional or psychological abuse is the infliction of mental or emotional anguish, e.g., humiliating, intimidating, or threatening.
"Financial or material exploitation is the improper act or process of an individual, using the resources of an older person, without his/her consent, for someone else's benefit.
"Neglect is the failure of a caretaker to provide goods or services necessary to avoid physical harm, mental anguish or mental illness, e.g., abandonment, denial of food or health related services.
"Self-neglect is characterized as the behavior of an elderly person that threatens his/her own health or safety.
Reporting Elder Abuse
To report elder abuse, contact APS through your state's hotline. The APS agency screens calls for potential seriousness, and it keeps the information it receives confidential. If the agency decides the situation possibly violates state elder abuse laws, it assigns a caseworker to conduct an investigation (in cases of an emergency, usually within 24 hours). If the victim needs crisis intervention, services are available. If elder abuse is not substantiated, most APS agencies will work as necessary with other community agencies to obtain any social and health services that the older person needs.
The older person has the right to refuse services offered by APS. The APS agency provides services only if the senior agrees or has been declared incapacitated by the court and a guardian has been appointed. The APS agency only takes such action as a last resort.
The Role of the Administration on Aging
AoA has a strong commitment to protecting seniors from elder abuse. Our community-based long-term care programs allow millions of seniors to age in place with dignity. AoA also supports a range of activities at the state and local level to raise awareness about elder abuse. These activities include training law enforcement officers and medical professionals in how to recognize and respond to elder abuse cases, conducting public awareness and education campaigns, and creating statewide and local elder abuse prevention coalitions and multi-disciplinary teams.
AoA funds the National Center on Elder Abuse (NCEA) to serve as a resource for the public and for professionals. NCEA consists of a consortium of five partners: the National Association of State Units on Aging, the lead agency; the Commission on Law and Aging of the American Bar Association; the Clearinghouse on Abuse and Neglect of the Elderly of the University of Delaware, which has an on-line searchable database; the National Adult Protective Services Association; and the National Committee for the Prevention of Elder Abuse.
NCEA provides elder abuse information to the public and to professionals; offers technical assistance and training to elder abuse agencies and related professionals; conducts short-term elder abuse research; and assists with elder abuse program and policy development. It manages an elder abuse list serve for professionals in the field, and it produces a monthly newsletter. NCEA's website contains many resources, including a list of the state elder abuse hotlines and information on publications, community coalitions, and upcoming conferences.
A top resource - National Council for Aging Care : Guide to Recognizing Elder Abuse