The Daily Beast and About.com have published interesting articles that address the tricky subject of sex in nursing homes. As the article on About.com explains, many long term care residents will spend the remainder of their lives in a nursing home so the responsibility falls to the facility to ensure that their residents live the rest of their lives with as much dignity and enjoyment as possible.  The nursing home is their home.

However, nursing home residents face many obstacles to enjoying themselves in a safe environment.  Doors without locks, single beds, and roommates all serve as structural obstacles to normal consensual sexual activity.  Additionally, as The Daily Beast explained, residents of nursing homes are frequently treated as children and their sexual desires are ignored or discouraged.

Dementia further complicates things.  Residents suffering from the disease may be more aggressive and violent, and are a greater risk of being impulsive.  Also, memory loss from dementia can cause a resident that has been married for years to forget that he or she has a spouse or cause them to mistake another resident for an intimate partner.  More importantly, the inevitable problem of sexual abuse of a vulnerable adult makes sex in a nursing home even more difficult to control.

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The Des Moines Register had an interesting article about the two Iowa nursing home administrators face licensing charges as a result of sexual abuse that took place in the homes they managed.   "It’s the first time in at least 10 years that the Iowa Board of Nursing Home Administrators has charged individuals with negligence for resident-care issues in the homes they managed."  The administrators are alleged to have played an active role in concealing evidence of resident-on-resident sexual abuse within their care facilities.

Too often, employees are scapegoated by higher-ups for adverse events the employees had little control over,” Lerner said. “The responsibility for these events — one prime example being understaffing — should be laid at the feet of executives interested only in profits.”

One of the cases involves Cynthia Gentz, who served as administrator of the Abington on Grand nursing home, from November 2008 through 2011.  State records indicate that in 2009, shortly after a resident was admitted to the Abington, the resident threatened to kill people and sexually accosted other residents of the home. "The staff told state inspectors the man committed sexual acts with other residents on a daily basis — grabbing their breasts, putting his hand between their legs and kissing them. One worker allegedly told inspectors she saw the man engaged in sex with another resident, but the worker stated the charge nurse instructed her to simply keep an eye on the two. Records at the home also included references to the man’s “inappropriate sexual behavior with high school volunteers,” inspectors alleged."

"The owner of the home, American Healthcare Investment of Oklahoma, manages 10 state-licensed care facilities in Iowa. Its president and sole shareholder is Brian Hoyle, a California real estate broker and banker. The home is managed by Healthcare Management Services in Ankeny, a company run by Michelle Zimbelman, an accountant who is one of Hoyle’s business partners."

"Between 2005 and 2008, the home spent more than three years on a federal list of some of the worst homes in the nation. Over the years, inspectors have reported finding dead mice in the kitchen, police had found lost residents wandering in traffic near the home and administrators have repeatedly been cited for hiring workers without conducting the legally required background checks."

Etter with the misdemeanor offense of attempting to interfere with state inspections. Court records indicate she was acquitted of the charge after a trial.

 

ChicoER had an article about allegations of abuse at Evergreen Gridley Healthcare Center in California. William Bonds alleges he was not properly treated and was forced treatment on him that he didn’t want.   According to the suit, Bonds, now deceased, was admitted to Evergreen Gridley Healthcare Center on Sept. 8, 2009, because of "functional decline."  The lawsuit, filed by Bonds’ daughter Shirleen Latham states when Bonds was admitted, his doctor had ordered that he receive Aldactone, a diuretic to control the buildup of excess body fluids, and leads to death if untreated.

Evergreen did not administer any diuretic until Sept. 11, and as a result, Bonds’ body began to swell, especially his legs. That same day, when the patient’s doctor was informed of this problem, he ordered Lasix, but none of it was administered until Sept. 12.

"The several days Mr. Bonds went without a diuretic resulted in severe generalized edema (accumulation of fluids), which became difficult to control and resulted in severe and painful skin blisters," the suit stated. "Furthermore, as a result of the severe edema, Mr. Bonds’ health condition significantly deteriorated and he lost interest in his own health. He subsequently began to refuse health care."

On Sept. 14, Bonds was unable to eat his meals. When he failed to have a bowel movement for several days, he was given a laxative, which did not help. He was dying.  Then he was given a suppository, which he did not want and which also had no effect.  He became very upset about the suppository because "by this point he simply wanted to be left alone to die as peacefully as possible."

The next day, a registered nurse told a licensed vocational nurse to give Bonds an enema. The licensed vocational nurse reminded the registered nurse that the patient was on "comfort care" and that he was not to be given unnecessary treatment, and especially treatment he did not want.

The RN ordered the LVN to give the enema anyway. The LVN discussed the matter with Bonds, who insisted he did not want the enema. So the LVN complied with his wish.  The LVN who disobeyed the RN was fired immediately.

Then the RN got two other staff members, physically restrained the frail and weak Bonds, and despite his "protestations and screams," forced him to have the enema, "causing him extreme physical and emotional distress." This was done, even though the nursing home administration knew "that Mr. Bonds was on comfort care and was mentally capable of refusing consent to any treatment."    Bonds was of sound mind, he had the right to deny any treatment he did not want as long as withholding it didn’t jeopardize the health or safety of anyone else.

Evergreen Gridley Healthcare Center is owned by Evergreen Healthcare Management, a company based in the state of Washington.  It manages 43 nursing homes, including three in Butte County. Besides the one in Gridley, it manages Twin Oaks in Chico and Olive Ridge Care Center in Oroville.

 

 

The Democrat and Chronicle had an article about the licensed practical nurse admitted that he had sexual contact with a mentally incapacitated patient at a Rochester nursing home. Kipper Allen Stevens pleaded guilty to a misdemeanor of endangering the welfare of an incompetent or physically disabled person for assaulting the patient on Dec. 21, 2008, at Shore Winds nursing home.  Stevens admitted to a police investigator that he had sex with the woman. 

A co-worker witnessed sexual contact between Stevens and the woman and notified the nursing home’s management a week later. During the investigation, Stevens told an investigator that he and the woman "were two consenting adults having a relationship" and denied having forcible sex with the woman. But he acknowledged it was improper for a caregiver to have a relationship with a patient.

Stevens also had been charged with second-degree rape, a felony which could have sent him to prison for up to seven years. Stevens only faced a maximum penalty of one year in jail for the misdemeanor but will receive nine months in jail with one-third off the sentence for good behavior, he’ll be free in six months.

 

 

 

WQAD had a story about the cover up of sexual abuse at Windmill Manor nursing home. State and federal authorities have levied more than $92,000 in fines where staff are accused of covering up the sexual abuse of an elderly resident.  State records say a male resident of Windmill Manor was found in bed with a female resident in November, and both were undressed. And then, on Christmas Day, staff saw the two having sex. Staff did nothing to prevent the two from engaging in sexual activity.

In addition to the fines against Windmill Manor nursing home, criminal charges were filed recently against its former director of nursing, Karen Etter.  Regulators also allege that Etter warned staff members not to tell anyone of the incident if they wanted to keep their jobs. Regulators say the woman, who has Alzheimer’s disease, could not have given informed consent to sex.

 

The DesMoines Register had one of the most disturbing articles I have ever read.  Daniel Larmore is the chairman of the board that oversees Iowa’s nursing home administrators.  That board is charged with licensing and disciplining Iowa’s nursing home administrators — but it has taken no action against an administrator in two years.   He characterized the sexual abuse of a resident in his facility as a "meaningful" relationship that caused no harm to the resident.  How dare he say such an irresponsible thing.  Who the heck does he think he is.

Larmore was the administrator at the Harmony House care center in Waterloo.  State records show that Larmore himself faced allegations from the state inspectors in 2004 — and was never investigated or disciplined by the board.  The incident resulted in a $3,500 fine against the facility, a detailed report of the inspectors’ findings should have been sent to the Iowa Department of Public Health, which would have passed the information on to the board for its review.  It is unclear whether Larmore’s case was ever sent to the board for consideration. But Larmore has also acknowledged to the Register that the board failed to review some cases that were sent to the board for potential disciplinary action.

In June 2004, the Iowa Department of Inspections and Appeals alleged that Larmore failed to properly investigate and respond to complaints that a female nurse aide had repeatedly engaged in sex with a brain-injured, 29-year-old male resident of the home. The aide’s co-workers had witnessed several suspicious encounters between the resident and the aide, and had reported their concerns to supervisors. At one point, the resident’s roommate complained, saying the two seemed to be having sex on the other side of a privacy curtain.

State inspectors accused Larmore of making little effort to investigate the matter when an employee first voiced her suspicions. The state also alleged he failed to separate the resident and the aide once the complaints were made. The aide finally confessed to having sex with the resident.   In a written response to the state’s allegations, Larmore argued that sex between the caregiver and the resident did not cause injury or harm to the resident.  The resident had a brain injury and clearly could not have given consent.

Larmore wrote: "The relationship was initiated by, and was meaningful to, (the resident). … The presented situation was one of mutual interest of a (resident) and a caregiver and, although inappropriate, did not present potential or actual harm to the consumer due to the reciprocal fond relationship."

In Iowa, a professional caregiver who engages in sex with a nursing home resident can be criminally charged with dependent-adult abuse. Larmore acknowledged in his response to the state that after the first concerns were voiced about intimate or inappropriate contact between the resident and the aide, he didn’t talk to other employees or to the victim. In May, before Larmore resigned as Harmony House administrator, he fired nurse aide Tina Turner, 29, for allegedly having sex with a resident of the home and providing the man with marijuana.

Turner denied the allegation. One of her co-workers alleged Turner confessed to disconnecting the man from his ventilator so he could inhale the drug, saying, "I didn’t want to kill him or anything. I just wanted to get the dude high."
 

So this SOB covers up the sexaul assault of a brain damaged resident and fails to properly investigate of prevent it and he gets rewarded by becoming the chairman of the group that investigates Administrators?  Are you kidding me?
 

Santa Cruz Sentinel has an article about the tragedy that is all too common for many nursing home residents.  Nursing homes fail to train on what DNR status means, and far too often simple care is not provided that would save a resident’s life.  Below are excerpts from the article.

The Tragedy: On Sept. 11, 2007, a 71-year-old woman with cancer was transferred to Pacific Care Manor, a nursing home in Capitola. Just prior to her admission, the woman’s doctor noted that her patient was lucid and responsive and "could have years to live." Most importantly, the patient had also expressed a desire to live.

Shortly after her admission, the woman began refusing food, water and any treatment. Within two days, she was screaming and combative. On day three, the nursing staff suggested that lab work be ordered to determine the cause of the resident’s distress. The facility’s director of nursing overruled the suggestion because "once we know what is going on then we will have to treat her." Instead, the nursing director asked the facility doctor to prescribe pain medication and a "do not resuscitate" order. The doctor complied and, despite the woman’s documented opiate intolerance, he prescribed a Fentanyl patch, Haldol, morphine. He also wrote an order for "no CPR, no hospitalization." His patient cried out "you are all going to kill me" after the forcible administration of the prescribed medications. On Sept. 16, just five days after her admission, the resident died. 

All residents of nursing homes have the right to grant or withhold consent to any proposed treatment.  Residents have the right to refuse or consent to treatment and to receive all information relevant to making their treatment decisions. Providing such information is part of any responsible nursing home’s assessment and care planning process. Federal regulations also reaffirm residents’ rights to informed consent and to refuse treatment.

Regardless of a resident’s mental capacity, no facility may administer treatment unless the resident has agreed or has been specifically adjudicated incompetent by a state court judge. Even after a court has determined that a resident is incompetent, it must make additional findings before terminating a resident’s right to refuse treatment. Without a court order, the provision of any treatment over a resident’s express refusal is a violation of several residents rights and is criminal battery.

Similarly, doctors cannot order "Do Not Resuscitate" orders without the written authorization of their patients. For DNR orders, designated health care agents may sign for the patient. However, doctors may not unilaterally impose DNR orders without a resident or resident representative signature.

Nursing homes throughout California are accustomed to interposing their notions of a resident’s best interests over the expressed wishes of their residents. The Department of Public Health and resident advocates have been generally weak in preventing this illegal conduct. Hopefully, the tragedy in Capitola will serve as a warning to both facilities and advocates about the deadly consequences of disregarding residents’ critical rights to direct their own treatment.

Anthony Chicotel is an attorney for the California Advocates for Nursing Home Reform in San Francisco.