Expert: Mary Gordon - 7/25/2007

Question
Hi Mary,
It has been exactly four years since you responded to a question I had regarding my Dad's alzheimers and just about when we could have been expecting the 'end stage.'  You were so capable, comforting and knowledgeable that I dropped you a line when things were over.  Thank you once more.

A different problem, similar subject:
A friend's daughter is a nursing student and was on the receiving end of a sexual advance by a nursing home patient:
Her father said it this way:

"An elderly dementia patient grabbed her by the breast, and she instinctively slapped his hand off, and told him if he didn't stop it she would slap his hand again. Thinking that was the end of it.

She received a phone call at home from her boss, informing her that another co worker had filed a report saying she had assaulted this man and threatened him, and so she is suspended from work, and because there is a report of this nature, the police must investigate.
She is devastated.
She loves the elderly at this nursing home and does not have a violent bone in her body.
Because of these procedures that must followed through, it will probably mean her career is over, not because she is guilty but because she needs to work to survive, and if it goes to court could take months. she barely survives on the pittance a trainee gets now.
Another student responded in a similar fashion as well as two others on the same day."
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The question is: would not a nursing home be required to have specific protocols in place for situations such as this?
How often we hear of fellow patients being sexually assaulted by other patients who, if they were in their 'normal' or former mental condition would never consider such behavior.  My guess is that the elderly man would be aghast if he realized it.

It would seem that the nursing home would not only document such incidents but actually flag his chart for the other potentially more serious incidents.

What are your thoughts on this?  I am quite certain that this dear, gentle young woman was doing her very best with an extremely difficult situation.

Thanks Mary,
God bless,
Sue

Answer
Hi Sue,

Nice to hear from you again. A couple of things occur to me.

By law, an employer has an obligation to identify workplace hazards faced by its employees, and ensure there are procedures and other methods in place to protect workers from those hazards. Nowhere is it more important than in a nursing home where a very high percentage of the mostly female staff in will have been abused by patients - verbally, physically, or by sexually inappropriate behavior. These are not unusual occurrences in dementia units - as I'm sure you know - hitting, spitting, swearing, biting, scratching, kicking, pushing - and sexual aggression, such as groping or worse.  

The patient may not be fully accountable for his or her behavior because of their dementia, but that doesn't let the nursing home off the hook.  They have a legal duty to prepare students, volunteers or new staff coming into this environment, by identifying residents who pose a risk to caregivers or other residents. If I'm reading you correctly, the gentleman who assaulted her, grabbed a couple of ladies on the same day, and I'm willing to bet money this wasn't his first incidents of touchy stuff.  Was his propensity identified to her in advance? Did the nursing home have any kind of behavior management plan for him?  Was she instructed on how to react if she was attacked or assaulted by a resident? Was she told what was a reportable incident on the ward? Was she told who to tell?

She is a young student and thus cannot be expected to have the knowledge and experience of full time staff.  Students are normally expected to require special attention from supervisors, which has to include not just learning by doing, but by verbal instruction - which I think has to include specific identification of potentially dangerous or abusive situations and what to do about them. If she had not been warned about "Mr. Hands" or how to react, I can see it being completely shocking and surprising to a naive young woman. Most women would be horrified and have given him a slap before their brain even processed a thought on what to do.   

Dementia patients require special skilled handling to avoid outbursts or other undesirable behaviors. Brain damaged people just aren't like "regular" patients, and staff have to be instructed on what to expect and how to view it. How would a young woman coming into a dementia ward have known what to expect or how to handle it, unless there was explicit discussion and close supervision (not to police her, but to support her, help her learn).

I hope she has consulted with a lawyer - if it does come to any kind of hearing, particularly if it may impact her future employment in her chosen profession - I would definitely put forward the facts that she was a student, she was not adequately warned, trained, or supervised, that several other women had been similarly sexually assaulted the same day by the patient.  

Is there a union or other employee organization to go to bat for her? Can she report the sexual assault so it's on record, if no where else but at the nursing home? I would be really amazed if she was held accountable as a student involved in a single incident, particularly when it was response to an assault on her person.

She will know better for next time, but I think the nursing home is the most at fault. Her supervisor was negligent not to have found a way to deal with this in house before it went to the police.

I work for an electrical utility, obviously a dangerous work environment - and we don't expect students to have knowledge, experience and the judgement that takes time to develop - and knowing that, we look out for them, support them, and supervise them much more closely than regular staff.

I'm totally amazed that the co-worker would report her like that. Usually places that employ students seize incidents like that as "teachable moments" to have a staff discussion about what to do next time.

Not sure if this has helped at all.

Mary G.