Why aren't nursing home residents reporting abuse? Fear of retaliation, study finds.

Fear of retaliation from staff is a major barrier to nursing home residents asking for their needs or complaining of abuse or neglect, a new survey found.

The survey by the Long Term Care Community Coalition, a nonprofit organization that advocates for residents in nursing home and assisted living facilities, examined 100 complaints by nursing home residents across the country.

The report published this week sheds light on systemic issues in U.S. long-term care that can exacerbate neglect and poor facility conditions, including underpaid and overworked staff − factors that worsened during the pandemic, experts say.

Lead researcher, Eilon Caspi, an assistant professor at the University of Connecticut Institute for Collaboration on Health, Intervention and Policy, examined the surveys and complaint investigations by the Centers for Medicare and Medicaid Services. The report, titled ” ‘They Make You Pay’: How Fear of Retaliation Silences Residents in America’s Nursing Homes,” details complaints investigated between 2017 and last year.

Fear of retaliation can be a major barrier for “reporting, detecting, and investigating abuse and neglect,” Caspi and his team wrote.

“While exploratory in nature, we believe that this review represents the most in-depth examination of this phenomenon to date and hope that it will contribute significantly to our understanding of this harmful yet largely invisible source of resident suffering in America’s nursing homes,” they wrote.

While quality of care issues are well-known in U.S. nursing homes, residents’ fears could be a factor leading to underreporting and underestimating neglect or abuse, said aging and long-term care expert David Grabowski, a professor of health care policy at Harvard Medical School.

“There are real fears here that, at the end of the day, there’s going to be retaliation,” he said. “I do think the vast majority of staff members are good people working hard, and many of them are underpaid and undervalued. But I think these issues come up, and when they do, they should be addressed.”

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Terry Fulmer, president of the John A. Hartford Foundation and leading expert in elder abuse and geriatrics, said educating staff on the harms of retributive statements should be key in fighting the problem.

“What we already knew but learned again in horrific detail during COVID was that care in nursing homes is unacceptable,” she said. “Let’s understand the phenomenon. Let’s name it, let’s teach, how to prevent it, how to anticipate the way it feels to families and older people and the staff.”

In one of the complaints in the report, stemming from a resident in a northern California facility, residents told investigators they were afraid to voice concerns “because it backfires on you,” as “staff became aggressive.”

Other complaints detail sexual abuse allegations against staff, residents sitting in soiled conditions, and staff threatening family members of residents if they reported issues to the state or ombudsman association.

“You are dependent on staff members to provide you with basic care, continence, using the bathroom, the toilet, taking a shower,” Caspi told USA TODAY. “So you can feel very small, and there’s an inherent asymmetrical power… a power imbalance between residents and staff members.”

John Rowe, professor of health policy and aging at Columbia University Mailman School of Public Health and the Butler Aging Center, said examining the conditions of staff is key to improving nursing home conditions and preventing neglect and abuse. He said the self-reported complaints reflect an understaffed workforce “dealing with the toughest patients.”