ANNAPOLIS — Edith C, a frail, elderly resident at Baltimore’s St. Elizabeth Rehabilitation and Nursing Center, drew comfort from one of her most personal possessions – a teddy bear.
But around 11 a.m. Aug. 26, 2001, nursing assistant Nicheia M. Powell, 22, used the cuddle toy to attack the woman in a fit of rage after the resident soiled herself while the assistant was cleaning her, according to court records.
Edith C.’s case – her identity is protected in court records – is one of hundreds reported across the state annually, as Maryland’s nursing home industry experiences a steady increase of reported elderly abuse cases over the past decade.
Her case is typically sad.
Powell, who was convicted in Baltimore District Court Wednesday and sentenced to a two-year suspended jail sentence, grabbed the stuffed bear out of Edith’s arms and began “hitting victim C. very hard in the back and top of the head and in the face area” with the bear, the records said. Powell then “tried to stuff the bear in victim C’s mouth,” as a fellow nursing assistant pleaded with Powell to stop.
Powell eventually did and went back to her duties. The pair cleaned Edith and sat her in her wheelchair. The witness then stooped behind Edith and began braiding her hair.
That’s when the witness heard Edith scream again.
“Shut up and be quiet,” Powell told Edith as she stood with her full weight on both of the woman’s feet. Powell was wearing hard sole shoes at the time.
Again the witness screamed for Powell to stop. This time, Powell did and left the room.
In 1994, the Ombudsman Program at the Maryland Department of Aging collected approximately 424 reported cases of abuse in nursing homes.
In 2000, there were 1,080 cases of alleged resident abuse reported to the Department of Aging, with 469 of those being resident-to-resident cases.
Because abuse cases may be reported to different state agencies whose records don’t necessarily overlap, the actual number could be higher.
Some in the industry speculate that a severe nursing shortage may be to blame for the increasing violence.
As the population of seniors has risen steadily, the number of nurses has declined during the past decade. The shortage means fewer nurses working longer hours creating high stress levels – a situation ripe for abusive behavior, some experts say.
Both the quality of care and work is affected, said Carmen Morano, a social work professor at the University of Maryland who has been studying the issue.
“Someone has to pick up the slack,” Morano said.
That may mean having to work harder for the same pay, which is low to begin with, Morano said. The average wage for a nursing assistant is about $11 an hour.
Many of those who work in the industry agree.
“I don’t want to justify (patient abuse), but (the reasons for it) tie into two things,” said Larry Rubin, a spokesman for nursing assistant union SEIU 1199E-DC. Those are stress caused by the nursing shortage and poor training, he said.
Those factors are what Patricia Bayliss, the ombudsman for the Maryland Department of Aging, also has found to be two of the main contributors. Part of her job is to advocate for patients and monitor cases of abuse in Maryland.
“It’s probably because you’re dealing with people and people are sometimes prone to conflict,” she said. “There’s a lot of caregiver stress, and sometimes that results in an explosive situation.”
Offering extensive training to those entering the nursing and nursing assistant field in dealing with stress and patient interaction would help, she said.
But even that may not prevent an Edith C. situation.
Her abuser, Powell, passed a criminal background check, drug test and underwent extensive training, said Christine Mour, an administrator at St. Elizabeth.
“We screen people very carefully before hiring them,” Mour said.
Powell, who was in her fourth week on the job, was fired soon after the incident occurred, Mour said.
Other industry experts say the increase in abuse cases is actually caused by rising awareness and a greater number of cases being reported, Morano said. But there’s no way to know for sure.
“Part of the problem is, is it a chicken or an egg phenomenon?” he said. “Is it more abuse or are we just more sensitized to look for it?”
Regardless of cause, the problem persists.
The steady increase in reported cases has prompted more aggressive prosecutions from the attorney general.
“We get about 40 (abuse cases) a month in our office,” said Attorney General J. Joseph Curran Jr., whose office prosecuted Powell for second-degree assault.
Of the roughly 480 cases Curran’s office gets in a year, only about 20 get to court, Curran said.
That’s because, unlike the incident with Powell and Edith C., many cases don’t have witnesses, he said, making successful prosecution a lot harder.
Curran’s office prosecutes only claims of abuse in Medicaid-funded nursing homes. Other abuse cases in non-Medicaid funded homes are handled by each county’s states attorney and police.
“As the population of seniors keeps growing, there’s going to be a need for better-paid and better-trained caregivers,” Curran said.
But he’s also quick to point out that of the nearly 30,000 nursing home residents in the state, they only get complaints from about 500.
“It’s a small number complaining,” he said, “but it’s also a small number of caregivers slipping through the cracks.”
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