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The newspaper's investigation found that of the 107 Type A citations that were issued over the past three years, only seven were prosecuted as crimes. Type A citations are the most serious that the state issues and are reserved for severe neglect or abuse that typically leads to severe injuries or death of residents.

The newspaper found that so few were prosecuted due to a combination of complicated system and the lack of will. The state attorney general is notified of all Type A citations, but must get the permission of local prosecutors to prosecute them as a crime. Most local prosecutors are never informed of the cases. In addition, the investigation found that at least five of the cases over the past three years were never even properly delivered to the attorney general.

Though this investigation focused on Kentucky, there is a similar lack of will to prosecute nursing home staff and administrators throughout the country. This is why it is important for nursing home residents and their families to be diligent in detecting and preventing abuse and neglect.

For more information on nursing home abuse and neglect, please visit the Nursing Home Advocates.

Issues Discussed in the Post:

Nursing Home Neglect and Abuse

Nursing Home Injuries

Nursing Home Deaths

Nursing Home Abuse Detection

Nursing Home Abuse Prevention

We originally wrote on the story of Frances Tanner two months ago when the original verdict was reached. After awarding Tanner's family $1.1 million for pain and suffering, the jury leveled the staggering $28 million punitive damages judgment due to the evidence of gross abuse and neglect that had occurred at the nursing home and led to Mrs. Tanner's death.

Tanner had become bedridden due to a hip fracture that resulted from a fall was not recognized by the staff and, while confined to a bed, developed a fatal bed sore. Severe bed sores like Mrs. Tanner's are almost always the result of nursing home staff failing to turn the patients properly.

Though the nursing home complained that the punitive damages judgment was excessive, the judge called the trial "a classic demonstration of how well the jury system works." He said the large judgment was justified because the evidence demonstrated that the home "based, time and again, predominantly on a concern for the bottom line" instead of patient care, as evidenced by their improperly trained workers.

Punitive damages are an often-misunderstood part of the legal process. They are separate from compensatory damages, which are designed to compensate victims and/or their families for medical bills, lost wages, and/or pain and suffering that result from the defendant's bad acts. In the Tanner case, this would be the $1.1 million judgment.

Punitive damages, on the other hand, are designed to punish the defendants and remove the financial incentive to cut corners. Due to the pattern of neglect and abuse and concern for profit over patient care in this case, the jury and the judge decided that the $28 million punitive damages was needed to force them to change their entire corporate culture.

For more information on nursing home abuse, visit the Nursing Home Advocates.

Prior posts on this topic:

California Nursing Home to Pay $28 Million in Death

The auditor found that the Department of Public Health failed to collect millions in fines between the years of 2003 and 2010.  The department inappropriately reduced financial penalties to some facilities, failed to adjust fines to the rate of inflation, and did not always conduct surveys in a timely manner as required by law.

In addition to depriving the department of revenue, the department's lax enforcement also sends a message to nursing home operators that safety regulations are not taken seriously.  "The state is not collecting money from nursing homes that violate the rules, and that sends a message to the industry," said Carol Herman of the nonprofit group Foundation Aiding the Elderly. "Nursing homes have no incentive to clean up their acts, because the regulators are not doing their jobs."

This story illustrates that, while state regulatory agencies play an important role in preventing nursing home abuse and neglect, they do not always do their job to the best of their ability.  This is why friends and family of nursing home residents should be diligent in looking for signs of abuse and neglect. 

For more information on identifying signs of abuse and neglect, visit the Nursing Home Advocates' Abuse Detection information page.

According to a 2009 report, financial exploitation costs the elderly $2.6 billion each year.  According to the Cleveland Jewish News report, financial exploiters typically target single women who are dependent on others for care.  Financial exploitation can happen to elderly people who live alone or in nursing homes or assisted living facilities.

If you have a loved one in a nursing home or assisted living facility, you should pay close attention to their financial matters to ensure that financial exploitation does not occur.  Some warning signs include:

* Sudden interest in banking transactions
* Forged Signatures on financial or banking transaction
* Withdrawal of large amounts of money
* Expanded withdrawal of small amounts of money
* Cashing of checks without proper approval
* Possessions and assets disappearing
* ATM withdrawals that are not approved
* Change in living will that does not reflect the individual
* General changes in financial matters
 

For more information on financial exploitation, visit the Nursing Home Advocates' Financial Exploitation information page.

A few weeks ago, we wrote about the first part of the Herald Courier's investigation, which found that administrators at the nursing home National Healthcare-Bristol ignored suspicions about nursing aid James Wright for seven years.  Now, in a follow up report, the newspaper is reporting that police investigating a case in 2007 failed to even interview Wright despite the fact that he was the prime suspect and that Wright had been suspected by staff members of molesting residents since 2000. 

Police files say that Wright became a suspect only after a private investigator hired by an attorney began making inquiries.  Despite the evidence the private investigator uncovered that implicated Wright not only in the 2007 case but in other instances of sexual assault at the nursing home, police decided not to interview him and the case remained unsolved.

Wright left National Healthcare-Bristol in 2007 with good recommendations from his supervisors, despite the suspicions many of his coworkers had about him.  He took a job at an assisted living facility, where he is accused of assaulting a resident as well. 

The failures of the local police and nursing home administrators finally came to light in 2009, when state investigators connected Wright to the several unsolved sexual assaults at National Healthcare and the other facility.  Wright was convicted for four of the assaults and is currently in jail.

This investigation by the Herald Courier is a harrowing wakeup call that illustrates that authorities who are supposed to protect our elderly --  police and nursing home staff -- often fail in their duty.  If you have a loved one in a nursing home, you should always watch for signs of sexual abuse and pursue your suspicions vigorously.  For more information on sexual assaults, visit the

Ulloa was a caregiver at the Calabasas Silverado Senior Living home, which specializes in caring for residents with dementia and other memory-impairing diseases.  Ulloa abused four residents between February and November 2007.  The abuse first came to light after a Silverado staff member called the widow of a deceased resident and told her that her husband's death had been the result of abuse.  After authorities were alerted, they conducted a yearlong investigation before arresting Ulloa and 2008.

This case illustrates the importance of family members and staff members always being on the lookout for abuse.  Ulloa's abuse may not have come to light if not for the actions of the staff member and the victim's widow.  This is especially true in the case of residents with dementia or other illnesses that interfere with their ability to communicate.

For more information on detecting abuse, visit the Nursing Home Advocates' Detection Tips webpage.

While nursing home officials say nursing aid Angela Almore acted alone in administering non-prescribed doses of moprhine to patients to make them more manageable, Henson says she is looking at procedures at the nursing home which allowed Almore to commit this crime. 

“A nurse should not be able to just get access to morphine that is not prescribed for patients and give them to anyone they want to. This can't be just a rogue nurse gone bad,” Henson said.  The state licensing board is also investigating the nursing home for possible violations. 

Henson was interviewed by TV station WRAL about the investigation:

Henson's investigation illustrates the importance of having a good attorney on your side in nursing home abuse cases.  While Almore is rightfully being tried for murder, the nursing home should not be allowed to simply write her off as a bad apple and continue business as usual.  They should be forced to ensure that something similar does not happen to other residents in the future.

If you believe a loved one has been abused in a nursing home or assisted living facility, visit the Nursing Home Advocates website.

“We believe that keeping seniors well-informed provides the best defense against fraud and scams,” Goddard said. “Protecting seniors has long ranked as a top priority for the Attorney General's Office, and our Senior Anti-Crime University moves our efforts up another notch. I look forward to meeting with seniors and helping them avoid becoming victims of fraud.” 

Financial exploitation is a serious issue for all seniors, but especially for seniors in nursing homes and assisted living facilities.  Nursing home staff members and administrators may take advantage of vulnerable residents and attempt to bilk them of their assets.  Some warning signs of financial exploitation in nursing homes include:

* Sudden interest in banking transactions
* Forged Signatures on financial or banking transaction
* Withdrawal of large amounts of money
* Expanded withdrawal of small amounts of money
* Cashing of checks without proper approval
* Possessions and assets disappearing
* ATM withdrawals that are not approved
* Change in living will that does not reflect the individual
* General changes in financial matters

For more information on Attorney General Goddard's Senior Anti-Crime University, visit their website.  For more information on financial exploitation in nursing homes, visit the Nursing Home Advocates' Financial Exploitation Information page.

This case highlights the potentially lethal consequences of overmedication and the use of chemical restraints, which are among the most pervasive types of abuse in nursing homes and assisted living facilities. 

Chemical restraints are drugs intended to control a person's behavior.  They are used by nursing home staff members to restrain residents who present a danger to themselves or others.  The use of chemical restraints must be medically necessary and ordered by a physician. When used only for staff convenience, and not to treat an underlying medical condition, using drugs as a chemical restraint is against the law.

The side effects of improper use of chemical restraints are serious. More than limiting a resident's ability to function, the long-term use of chemical restraints can lead to diabetes, thyroid dysfunction, and central nervous system disorders, as well as liver, kidney, pancreas, and other organ damage.  Also, as in the case, the overuse of chemical restraints can even lead to death.

For more information on overmedication and the use of chemical restraints, visit the Nursing Home Advocates' Overmedication/Chemical Restraints Information page.

The core message of this year's World Elder Abuse Awareness Day is "Never ignore elder abuse."  The IPNEA says most elder abuse is hidden and caused by ageism and is working to expose abuse and fight ageism.

The IPNEA said the following in annoucing this year's World Elder Abuse Awareness Day:

Throughout the world, abuse and neglect of older persons is largely under-recognized or treated as an unspoken problem. Unfortunately, no community or country in the world is immune from this costly, public health and human rights crisis. Research indicates that public education campaigns like World Elder Abuse Awareness Day (WEAAD) are vital for informing people in a growing number of countries about elder abuse and active involvement of the media is central to its success.

According to the IPNEA, 4% to 6% of all elderly people have experienced some form of abuse in the home.  This percentage is much higher for elderly people in nursing homes and assisted living facilities, as 36% of nursing home staff say they have witnessed physical abuse in the last year, 10% admit to committing physical abuse themselves, and 40% say they have psychologically abused residents.

For more information on World Elder Abuse Awareness Day and elder abuse in general, please visit the following resources:

• INPEA
• National Center on Elder Abuse
• National Clearinghouse on Abuse in Later Life
• Administration on Aging

If you believe a loved one has been the victim of abuse, neglect, or exploitation while in a nursing home or assisted living facility, you should visit Solomon & Relihan's Nursing Home Advocates website.

James Wright, who worked at National HealthCare-Bristol from 2000 to 2007, is currently in jail serving a 60-year sentence for assault four residents at the facility.  Investigators have linked him to at least three other abuse cases and there are at least five other cases of abuse that occurred at the facility during that time period that may or may not be linked to Wright.  In addition, Wright is accused of assaulting a resident at another assisted living facility where he worked after leaving National HealthCare. 

The extensive investigation by the Bristol Herald Courier reveals that suspicions about Wright were well-known among staff and administrators at Bristol HealthCare for a long time.  In 2007, there were five complaints about Wright in the months leading up to his departure.  Despite this, he was not fired, but allowed to resign with positive recommendations.  He then got a job at an assisted living facility, where he is also accused of sexually assaulting a resident.

This is a classic example of a nursing home administration covering up abuse in order to save face and, in the process, allowing more abuse to happen.  When cases like this come to light, nursing home administrators will frequently try to shift all blame onto the perpetrator and deny any responsibility.  However, if they have suspicion that abuse is occurring and fail to take steps to stop it, they should be held responsible as well.

For more information on nursing home abuse, visit Solomon & Relihan's Nursing Home Advocates website.