Raising Awareness Regarding Sexual Abuse in Nursing Homes

The idea of sexual abuse occurring in a nursing home is something no one wants to think about. However, it is an issue that nursing homes must be aware of and diligent in their efforts to prevent. Sexual abuse is surprisingly one of the more common forms of abuse in nursing homes. The perpetrator may be a staff member, another resident, a stranger, or a family member. Whatever the source of the sexual abuse, a nursing home is responsible for providing the highest quality of care for its residents, and that care involves preventing possible sexual abuse. A nursing home can be held liable for negligence should sexual abuse occur, and it could face serious monetary fines and penalties.

Elderly nursing home residents are often frail and vulnerable to sexual predators. They may have medical conditions like a stroke or decreased mental capability that prevents them from reporting or physically avoiding a perpetrator. This also makes it difficult to substantiate and convict the offender when a sexual abuse incident occurs; so, nursing homes must make use of all the available ways to prevent any type of sexual abuse.

Sexual abuse by a nursing home staff member can often be prevented by doing due diligence with regard to performing background investigations before hiring an employee. Also, being thorough in interviewing and checking references of potential employees is an important key to not only preventing sexual abuse by staff; but, it can also help to ensure that the caregivers who provide much of the day-to-day care have the right attitude and sensitivity they need for the job. Nursing homes should endeavor to create a working environment that makes employees want to stay long-term. This involves having an adequate number of staff members who are well-trained and properly supervised, including with regard to sexual abuse-how to spot it and how to report it.

Many nursing homes have both male and female residents living on the same wing or floor, and that can contribute to sexual abuse perpetrated by one resident upon another resident. The same vulnerability of illness, inability to resist, and the inability to speak out can make a resident a target for sexual abuse by another resident. Here again, having an adequate number of well-supervised and trained staff is important.

Sometimes a family member may be guilty of sexual abuse. For example, if a spouse with diminished capacity is placed in a nursing home and the other spouse is lonely and initiates sexual intimacy, this can be considered sexual abuse if the resident cannot consent. This type of sexual abuse is frequently not reported by the staff because the couple is married; but, if it is allowed to continue,the nursing home may be liable for neglect.

Inadequate security may allow strangers to enter the facility; and, if that stranger is asexual predator, they may sexually abuse a frail elderly resident and escape before anyone realizes what they have done. Nursing homes can alleviate the potential for a stranger to enter the facility by making sure that staff secures the door when leaving or entering the facility. Staff should be trained in recognizing and questioning unauthorized persons or people whom they have never seen in the building.

A recent example of a stranger entering nursing homes to sexually assault and abuse elderly women happened in Charlotte, NC, where police were called when the staff of a health and rehab center found a man in an 85-year-old woman’s room claiming to be a family member. The man fled but not until after he sexually assaulted the woman. Then, even while being pursued by the police,three hours later in another nursing home, another elderly 84-year-old woman was awakened by the man in bed with her. Police believe that it is likely this man has committed similar sexual assaults in other nursing homes. The families of the two women were reported to be questioning what security measures were in place to keep the facility safe from intruders.

Signs of sexual abuse in a resident that staff should be trained to report include,but are not limited to –

Unexplained difficulty walking or sitting,
Bruising or thumbprints on a resident’s breasts, buttocks, thighs, or genital area,
Torn, stained or bloody undergarments,
Sheets that are bloody or stained,
Rope burns on the wrists or ankles and
A strong reaction to a particular staff member-fear, stress and anxiety-when that staff member tries to help the resident bathe, dress or go to the bathroom.

F-Tag 600 §483.12 Freedom from Abuse, Neglect, and Exploitation in the revised Appendix PP, State Operations Manual,includes a section on Sexual Abuse that can be used for education, and should be included in each facility’s abuse prevention and reporting policies. Obtain it by visiting the following link: https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/GuidanceforLawsAndRegulations/Downloads/Advance-Appendix-PP-Including-Phase-2-.pdf.