Residential Care Facilities Need Abuse Risk-Reduction Plans

I read an Associated Press story the other day which reminded me of the need for residential care facilities to adopt pro-active measures to reduce the risk of abuse of persons in their care.

The AP story reported that a man in Indiana was facing criminal charges for fondling a resident while the man was visiting his own mother at a mental health facility. The victim told police that the same man had done something similar on prior occasions.

This brief article focuses on the exploitative type of abuse, common in large residential facilities, where identification of the perpetrator is often a near impossibility. Fortunately for the victim in this case, she was able to identify the perpetrator. This means to me that she is able to speak, and further was able to have key staff respond to her report in the appropriate manner that led to an arrest and charges of two counts of sexual battery. If the police continue their investigation and dig deeper into the matter, there may be additional charges filed later on, hopefully resulting in a plea of guilty or in vigorous prosecution.

Perpetrators of sexual crimes in large licensed residential and health facilities most often go unidentified.

I remember a case in the early 1980’s where a 99-bed facility found that one of their female residents was seven months pregnant. Dr. Carol Berkowitz at Harbor General Hospital/UCLA conducted the medical exams of all of the residents and found that over 70% had Chlamydia and a large number also had gonorrhea. The facility director asked me to work with the administrative staff to help identify the perpetrator.

Several of the staff were feeling terrible, as they were not the perpetrator but, because they were male, they were looked at suspiciously by nearly everyone. Should all male staff be required to submit to DNA testing? Who was most likely to have been the perpetrator? Or perpetrators?

I worked with the staff on the difficulties. First, who had access to the residents? How many had access? How would they have committed these acts? I led the administrative staff through an analysis of the possibilities. Male administrative staff was first on the list! Of course, all denied any such conduct on their part.

We discussed all staff: professional full time staff, professional part time staff, paraprofessional staff, volunteers, outside vendors for transportation, day programs, physical therapy, medical visits, speech therapists, other visiting professionals such as physicians, psychiatrists, specialists, nurses. Then we thought about service providers for laundry, food, and other suppliers. We also considered visitors, like the man visiting his mother, brothers, uncles, grandparents, parents, and on and on. The number of men on the list continued to grow literally into the hundreds. Which men…or all men…should be tested?

Meanwhile community feelings of outrage were rampant. Not only that most residents now had STD’s but the pregnant young woman eventually had the baby which was made available for adoption. The facility was closed and all the residents sent to other places to live and receive medical treatment for their STD’s. But there was no mental health treatment of residents for the sexual exploitation or assault that was the way they had contracted these diseases.

This case, where the perpetrator was a visitor to another resident, is unusual. What are the protections that can be put into place to reduce the risk of assault? Many are considered too invasive, such as cameras in all areas including the patients’ bed areas and bathrooms. What about the corridors entries and exits? Would it capture what is needed? What about policies and practices that could have been implemented but were not?

In the case cited above the administration had actually reached out approximately one year before the pregnancy was discovered, to learn what protective and preventive policies and practices could be implemented, but they did not employ any of what was recommended. After the fiasco, they admitted that had they implemented the plans, it is likely that the perpetrator who caused the pregnancy would have been identified, and the rampage of sexual assaults may have been lessened, and definitely the pregnancy would have been discovered before the third trimester was complete.

So, while in this case I am glad that the perpetrator was caught, and the crime publicized, I would like to see a national outcry for better prevention policies to be written and implemented in all residential programs and facilities.