Yes, the RED hand, the hand no one wants to see on their Medicare Care Compare site, right? In June 2023, Long Term Care Community Coalition published the results of a study “They Make You Pay”, How Fear of Retaliation Silences Residents in America’s Nursing Home. As “caregivers”, yes, that is you, it doesn’t matter if you are providing direct care or managing the facility budget, you are a caregiver. You are entrusted to provide care for those who are not able to care for themselves and if the results of this study doesn’t send chills up your spine it might be time to pursue another career.

This study isn’t the first of its kind of course, it was actually initiated to respond to a 2011 University of Connecticut study that called for the implementation of interventions to address, among other issues, residents’ fear of staff retaliation. Sadly, staff retaliation against residents has been documented for at least 50 years including in a late 1960s study titled “Old Folks and Dirty Work: The Social Conditions for Patient Abuse in a Nursing Home”. There was also a report from the U.S. House of Representatives in 2001, detailing the aftermath of an incident involving an Ohio nursing home resident who sustained severe lacerations and bruises. When the resident was asked about the incident the resident replied, “he’ll beat me up again if I tell you”.

The information gathered in this study was not hard to find. Researchers reviewed about 835 statements of deficiencies from standard surveys and complaint investigations containing the word retaliation and 100 contained sufficient and compelling detail necessary to meet the project’s goals. Was your center a part of this sample, hopefully not! Enough shock and awe, bottom line, what are YOU doing when a resident reports an incident of alleged abuse. Remember, perception is reality, if a resident is afraid to come to you with concerns, you may have bigger problems. Look at your internal processes, are you following your policy regarding abuse and neglect? Does your educational calendar include mandatory training on resident rights and abuse prevention and reporting? Add this topic to your next QAPI committee agenda and discuss the results of this study. You can never do enough to prevent abuse as Ronnie (a resident interviewed in this study) says “fear of retaliation is not something you can look up in a dictionary, but if you live in a setting where you depend on others to care for you, you know exactly what it is”. Sad, just very sad. Stay well and stay informed!