DAILY NEWS CLIP: January 13, 2025

CT report shows fear of retaliation in nursing homes is a common problem in every state


CT Post – Saturday, January 11, 2025
By Jordan Nathaniel Fenster

Fear of retaliation from staff, as Connecticut’s Long Term Care Ombudsman learned from a recent survey, is largely universal in nursing homes and other elder care facilities.

With the help of University of Connecticut gerontologist and researcher Eilon Caspi, Long Term Care Ombudsman Mairead Painter asked her colleagues in all 50 states about what they’re seeing.

Not all replied, but the team collected stories and collated responses from 32 states and found that residents in elder care facilities often fear retaliation from staff. While details are sometimes different, the experiences are often similar.

“This is something that ombudsmen across the country see and are responding to on a regular basis,” Painter said. “There are so many similarities state to state, setting to setting, urban, rural people are experiencing this across the board.”

The 500-page report that was the culmination of the project details hundreds of stories from the 32 ombudsmen who were interviewed. Though the identities of the residents, the ombudsmen and the states they serve were kept confidential, many of the methods of retaliation were seen across the board.

“There is strong agreement in Connecticut’s nursing home sector that ongoing and continuous efforts to address a resident’s fears and anxieties about the potential for staff retaliation can significantly improve the quality experience in our state’s long term care settings,” said Matthew Barrett, president and CEO at the Connecticut Association of Health Care Facilities. “In this regard, we applaud and appreciate the resources that our long term care ombudsman program has put into developing programming in this area, including the recent research the program has funded that will benefit how other state’s view investing in training that can curb the fears and anxieties that many residents report when they perceive their ability to control their care to be lost when entering the long term care system.”

SEIU1199NE, the union representing workers in Connecticut nursing homes, said the findings in the report, “highlight widespread fear within these facilities and underscore the urgent need for systemic reforms to protect both residents and staff while fostering a safe, supportive environment. However, the broad scope of the study’s research detracts from the pressing, state-specific issues that Connecticut must urgently address.”

Long term care ombudsmen, Caspi said, exist as a check on elder care facilities and the staff they employ. If a resident feels they are being mistreated, they can complain to their state’s ombudsman who can investigate.

In their survey, Caspi and Painter found that some methods of retaliation against residents are more overt: A door intentionally left open when a bed-bound resident can’t close it; delay or denial of care; “pretending” to forget a residents’ food.

“Some of them will tell you, in your face, ‘Don’t ever dare call the ombudsman. Did you report on me? Don’t ever dare to do that again,’” Caspi said.

Other common methods of retaliation reported by ombudsmen are subtle enough that they might not be reported, Caspi said. One example is “the silent treatment.”

Some ombudsmen reported medication-related retaliation, including “forgetting” a resident’s medication, or bringing it to a certain patient last. “It could be somebody asking for their pain medication and the RN or the LPN, the licensed staff that dispense that, being demeaning to them, being degrading to them saying, ‘Well, you can’t have it now. You’ve got to wait two more hours,’” one ombudsman reported.

“You don’t even need words. Sometimes it’s just body language. You can look someone in the eyes in a certain way. You can make a gesture. That’s all you need,” Caspi said. “If you’re physically disabled, and you’re in bed and you need to be changed, and you press the button a few times, they’re not coming, are you going to complain?”

A hard look or an aggressive gesture from a staff member to a patient is often enough, Caspi said. “That’s all you need. After that, you don’t need to do much, because they know what can come.”
Hard to establish retaliation in isolation

Claims of retaliation are often difficult to prove, even if a nursing home resident overcomes their fear.

“If it happens behind closed doors in the bathroom, how do you prove it? If the resident is in the advanced stages of dementia, how do you prove it? It’s very difficult,” Caspi said.

The “elephant in the room,” Caspi said, is a nationwide lack of staff in elder care facilities. According to findings published by the American Health Care Association and the National Center for Assisted Living, there are open jobs in nearly every nursing home, and 89% are “actively trying to hire for registered nurse positions.” Almost three-quarters of nursing homes say workforce levels are now lower than before the pandemic, and most say their workforce has remained the same or gotten worse since before 2020.

That, Caspi said, results in consistent staff turnover and stress that ends up as retaliatory measures.

“They’re running around, they’re feeling stressed, they’re burned out, there’s a turnover, and then they snap. They just become so tired, they do double shifts, and then they just take it out on the residents,” he said. “That was a clear trend, the link between poor staffing levels and residents’ fear of retaliation.”

SEIU 1199NE President Rob Baril said that, “While regulations mandate adequate staffing, enforcement remains insufficient.”

“This is something our members have been raising the alarm around for years. As one of the ombudsman who participated in this project stated, ‘We are not doing an adequate job ensuring there’s enough staffing in nursing homes to effectively care for residents.'” Baril said. “This issue doesn’t only affect residents; overworked staff face serious risks, creating a hazardous environment for everyone.”

Though one ombudsman quoted in the report said retaliation against residents and the fear of it “is something that we will never completely solve. I think it’s part of the human condition that we can be fearful of things and this particular population is quite vulnerable on both a physical and emotional level.” Caspi and Painter did arrive at some recommendations, however.

One such strategy identified was better resource management in offices of ombudsmen that may not be well funded, and being as prompt as possible in responding to complaints. The use of volunteers was cited as a successful tactic.

Caspi and Painter also found that technology can alleviate some concerns. Where there are more cameras, there tends to be less retaliation, and the ability to communicate was also seen as an important factor.

A sense of “isolation” is “at the heart of this,” Caspi said.

“A lot of residents don’t have the ability to discretely, privately and securely communicate with the outside world,” he said.

For those residents, that communication begins with the ombudsman, Painter said.

“The only thing that I’ve really seen that helps is saying to residents, to family members, ‘I understand this can be really challenging when you’re living in a nursing home, and it must feel like you don’t have a lot of power or control,’” she said. “If you address it first and kind of call it out and have those conversations, it lessens the burden on the individual from having to bring it up.”

Access this article at its original source.

Digital Millennium Copyright Act Designated Agent Contact Information:

Communications Director, Connecticut Hospital Association
110 Barnes Road, Wallingford, CT
rall@chime.org, 203-265-7611