The phone rang shortly before Christmas in 2014.
When Maya Fischer answered, a nurse from the nursing home where her mother had been staying for more than a decade was on the other end of the line. In her Minnesota home, Fischer braced herself for difficult news.
“When you receive a phone call from the nursing home, your first thought is that … my mother has passed,” Fischer said.
The news was indeed troubling, but it was not what she expected.
“I was not at all prepared for the call that I received. … The call that my mother had been a victim of a sexual assault in her nursing home,” Fischer said. “For me and my family, it’s been devastating.”
Fischer testified in front of lawmakers in the nation’s capital on Wednesday. The US Senate Committee on Finance held a hearing to discuss reports of abuse and neglect in some nursing homes nationwide and what can be done to protect those of all ages at risk of abuse.
“My final memories of my mother’s life now include watching her bang uncontrollably on her private parts for days after the rape, with tears rolling down her eyes, apparently trying to tell me what had been done to her but unable to speak due to her disease,” Fischer said in the hearing, referring to her mother’s Alzheimer’s disease.
Along with Fischer, Iowa resident Patricia Blank testified about how she is the daughter of a nursing home neglect victim, Virginia Olthoff. In a news release on Tuesday, Iowa Sen. Chuck Grassley’s office noted how the nursing home where Blank’s mother resided and died “received the highest possible ranking from the Centers for Medicare and Medicaid Services (CMS) for quality of resident care, though it had been fined for physical and verbal abuse a year before Olthoff’s death.”
“How a place with the highest possible rating could yield such a tragic incident is just outrageous,” he said in the news release. “Things need to change, both for the standards at care facilities and for how CMS rates them. When American families consider where their loved ones can get the care they need, they should be able to rely on CMS information. That’s clearly not the case right now.”
After the hearing, Grassley said in a statement that Fischer’s and Blank’s stories were “troubling.”
“Today I heard troubling accounts, which lead me to believe continued oversight is needed in this area. There are two government watchdog agencies currently working on reports for Congress. One is the Inspector General of Health and Human Services and the other is the Government Accountability Office. I plan to convene another hearing on this topic after these agencies release their reports. I also intend to submit follow-up questions to each of the witnesses as we work toward reforms,” he said.
On Tuesday, CMS announced that updates will be made next month to the online tools for consumers to research nursing home quality: the Nursing Home Compare database, which allows users to compare nursing homes, and the Five-Star Quality Rating System, which rates nursing homes based on inspections, staffing and quality measures.
CMS also issued new guidance Tuesday that “clarifies what information is needed to identify immediate jeopardy cases across all healthcare provider types, which we believe will result in quickly identifying and ultimately preventing these situations,” such as abuse or neglect cases.
“Every nursing home serving Medicare and Medicaid beneficiaries is required to keep its residents safe and provide high quality care. We have focused on strengthening requirements for nursing homes, working with states to enforce statutory and regulatory requirements, increasing transparency of nursing home performance, and promoting improved health outcomes for nursing home residents,” Dr. Kate Goodrich, director of the Center for Clinical Standards and Quality at the Centers for Medicare & Medicaid Services, said in a statement Tuesday.
At Wednesday’s hearing, lawmakers pressed Goodrich on what has been done and what more could be done to ensure quality at facilities.
There were several factors mentioned about why a nursing home might fall behind certain quality standards, including being unable to retain qualified staff and conduct comprehensive background checks on staff.
“We do have expectations for nursing facilities for having the appropriate staffing for their patient population, and we survey for that on a regular basis,” Goodrich said in the hearing.
At the hearing, New Jersey Sen. Bob Menendez said in response, “I think there’s a gulf between the expectations and the reality in several of these instances and we look forward to working with you to bridge the gulf.”
‘The most vulnerable people in our society’
Wednesday’s hearing came just weeks after a sexual assault case at an Arizona health care facility involving a 29-year-old woman who has been in a vegetative state for years and gave birth in December. She has been a patient at the facility since 1992, according to court records. In January, a 36-year-old nurse was arrested on suspicion of impregnating the woman.
Among nursing homes, an exclusive CNN investigation in 2017 found that the federal government has cited more than 1,000 for mishandling or failing to prevent alleged cases of sex abuse, including rape and assault, at their facilities between 2013 and 2016 – before revisions were made in November 2016 relating to how CMS surveys and inspects long-term care facilities. Fischer’s mother’s case was one of several in CNN’s 2017 investigation. Her mother has since died.
“My goal by attending the hearing is simply to be my mom’s voice and to put a face with her name. I don’t want her to go down as being just another horrible statistic,” Fischer said. “Stronger legislation needs to be enacted to protect the elderly. These are some of the most vulnerable people in our society, and I don’t think that we’re doing enough to ensure their safety.”
Anyone – a nurse, family member or resident – can report nursing home abuse or neglect to CMS through state groups or a state’s long-term care ombudsman program, whose information is provided on the Medicare website.
State health investigators examine all types of abuse reported at nursing homes and assisted living facilities. In the case of nursing homes, state officials typically conduct these investigations on behalf of the Centers for Medicare & Medicaid Services, which regulates the more than 15,000 facilities that receive government reimbursements that pay for many residents’ care.