Investigating Abuse Within Communities: Complex and Challenging

Investigating Abuse within Communities: Complex and Challenging Randy Thomas Copyright: 2017

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Objectives • Identify the different types of investigations • Identify the possible perpetrators associated with the types of abuse • Identify the critical components of an internal investigation

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Administrative vs. Criminal

• Regulatory Agencies: Primarily administrative sanctions, does not have to violate criminal statutes. • Criminal Justice Agencies: Must violate criminal statutes. • Criminal investigations may be conducted by agencies without expertise.

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Issues • • • • • •

Complex and time consuming Delay in reporting “stonewalling” Evidence collection Too many suspects Lack of expertise/training

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The Trends • Resident on Resident violence • The increase in dementia issues • Decrease in critical resources (APS, law enforcement, mental health) • Requirement that local law enforcement conduct facility investigations (CMS)

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Institutional Risk Factors â&#x20AC;˘ Employee: substance abuse, family violence, poorly trained, role reversal, social isolation, financial problems, mental illness, insubordination

â&#x20AC;˘ Facility: high personnel turnover, high overtime, lack of staff training, staff shortages, crowding, inadequate managerial response to abuse

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Incidence of Abuse Is Unknown •

NCEA: 1 in 3 facilities cited. Staff interviews- 44% abused, 95% neglected or observed it, 50% of staff admitted to mistreating residents

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Most violations discovered after complaints, not as a

result of annual inspections •

Percentage of facilities with abuse violations

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Elder Mistreatment in Communities (JEAN, 2013) • • • • • • •

Physical restraint: 64.9% Neglect: 23% Physical Abuse: 14.9% Verbal and Psychological Abuse: 13.5% Financial Exploitation: 13.5% Sexual Abuse: 9.5% Medication Abuse: 1.4%

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Other Research • A nursing watchdog group found almost 800 registered sex offenders living in long-term care facilities • A study by the Journal of the American Medical Association focused on resident v. resident abuse in

Massachusetts. They found over 1,132 injury reports. • AoA reported 3,746 cases of resident v. resident abuse in

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Possible Perpetrators • Residents – Physical abuse – Sexual assault

• Staff – Neglect – Physical abuse – Financial exploitation

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FRAMEWORK FOR INVESTIGATIONS

Physical Evidence

Witnesses

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INVESTIGATIVE GOALS

WHAT

HOW

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Investigative Standards

• Cases Built on Facts • Must decide what happened • Who did it

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Critical Evidence • Physical Evidence – Records (medical, staff, training, policies and procedures) – Photographs (environment, injuries) • Witnesses (may not have direct knowledge) • Admissions (direct knowledge of the alleged incident or issue)

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Investigative Process • Structured process – Have a policy and procedure for internal investigations – Have a designated person or persons to conduct the investigation

• Have standard forms for statements, investigative narrative and case file structure • Recognize employee concerns • Be objective

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Interviewing

The interview is a non-accusatory process. It is a conversation with a purpose. It is designed to develop factual information such as who, what when, where and how.

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Method â&#x20AC;˘ Indirect Approach-this should be utilized first. Use open-ended questions. It is flexible and will provide more information. â&#x20AC;˘ Direct Approach-specific retrieval, closedended questions. Most effective as a follow-up to the indirect responses.

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Case Examples • Spartanburg – 88 year old female with advanced dementia – SNF – Family reported to law enforcement

• Leitner – Independent living – Family stock broker – Over $800,00 in assests taken by suspect

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Spartanburg • Facility conducted a complete internal investigation (statements from staff were outstanding) • Family was misinformed by hospital staff upon admission • Reported to law enforcement who found no criminal behavior

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Leitner • • • •

Residing in independent living Alcohol issues Suspect had access to money The facility had documented their concerns and reported the possible exploitation to social services.

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