Unreported, Uninvestigated & Unnoticed: Sexual Abuse in Nursing Homes

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“Sick, Dying and Raped in America’s Nursing Homes” was the attention-grabbing headline on a CNN investigative report released in February of 2017. It shined light on the fact that more than 1,000 nursing homes had been cited for mishandling suspected cases of rape, sexual assault, and sexual abuse — along with the likelihood that tens of thousands more got off scot-free.

In one egregious case, George Kpingbah, a nursing assistant who worked the overnight shift for nearly eight years at a senior care facility in Minneapolis, was caught raping an 83-year-old resident with advanced Alzheimer’s in the early morning hours. He eventually pled guilty to one charge of third-degree criminal sexual conduct with a mentally impaired or helpless victim. At the court hearing before the plea was entered, Kpingbah’s lawyer asked for leniency, arguing his client’s criminal conduct was “completely out of character.” Prosecutors, however, uncovered evidence the nurse had been suspended three times previously pending investigations of allegations of sexual abuse at the facility. He was sentenced to serve eight years in prison.

And in an unusual twist, in a separate civil settlement, Kpingbah agreed to pay $15 million to the rape survivor’s estate if he ever is convicted again of criminal sexual conduct or is ever found liable again for the abuse or neglect of a vulnerable adult in any subsequent cases.

However, the facility, Walker Methodist Health Center, was not cited or fined for any wrongdoing. The Minnesota Department of Health, the agency charged with licensing and regulating nursing homes in the state, found Walker Methodist had complied with all legal requirements since it had previously provided Kpingbah with abuse training and had maintained required staffing levels on the night of the rape.

The elderly woman’s daughter said simply: “You prepare for a phone call your mother has passed. You don’t prepare for a phone call that your mother has been raped.”

Laws Rarely Heeded

The report in the mainstream media raised the public’s hackles and maybe the awareness of the issue of sexual abuse in nursing homes for a time. But advocates for elders say the sad and sickening problem has persisted.

Federal law requires that whenever a facility receives information about suspected abuse, it must:

  • Take safeguards to prevent further abuse
  • Report the abuse to the controlling state survey agency, law enforcement, and other state officials quickly — within two hours after the allegation is made
  • Conduct a thorough investigation of the abuse alleged
  • Document and report the results of the investigation.

State laws and regulations often impose additional requirements for reporting and prevention.

In practice, however, these laws are ignored more often than not.

While working as a long-term care ombudsman responsible for protecting residents’ rights in California nursing homes, I became involved in several cases alleging sexual abuse. In a single year, for example, three complaints arose in one nursing home. The incidents involved:

  • A woman who claimed the visiting doctor assigned to the facility had unnecessarily touched her breasts and genitals during an examination
  • A man paralyzed from the neck down after a stroke who alleged an aide had sexually assaulted him while bathing and changing him
  • Residents who complained that a frequent visitor to the facility was openly having sex with two of the residents, both of whom had been diagnosed with dementia.

While all these allegations of sexual abuse were reported in written complaints to state authorities, all were found to be “unsubstantiated,” or lacking sufficient proof. The executive director of the facility “handled” the complaint against the aide accused of misconduct by firing him without additional investigation, noting: “There are already hundreds of applicants waiting to take his spot.”

The picture becomes even more grim with the realization that most sexual abuse in nursing homes likely goes unreported by the vulnerable seniors subjected to it. The range of reasons include embarrassment, fear of retaliation by the abuser or facility administrators, mental confusion or disorientation. Those who do report the misconduct to family members or authorities are often disbelieved or actively discouraged. For example, one police report noted in bold that the victim, a nursing home resident, was an “avid viewer of the television show ‘Law and Order,’” implying any facts she alleged were fiction.

Signs of Sexual Abuse

Given the dismal records authorities and administrators hold for detecting and preventing sexual abuse in nursing homes, family members, friends, and other outsiders are often the ones who must step in to report it. The National Consumer Voice for Quality Long-Term Care, a consumer advocacy group, enumerates specific symptoms to look for that may indicate sexual abuse has occurred.

Physical signs may include:

  • Bruises around inner thighs, the genital area, or breasts
  • Unexplained genital infections or sexually transmitted diseases
  • Vaginal or anal bleeding, pain, or irritation
  • New difficulty sitting or walking
  • Torn, stained, or bloodied underclothing
  • An older person’s report of being sexually assaulted or raped.

Social Indicators of Sexual Abuse Include:

  • Extreme agitation
  • Withdrawal from social interactions
  • Panic attacks or emerging symptoms of post-traumatic stress disorder (PTSD)
  • Suicide attempts.

Resources for Additional Help

Organizations offering valuable support and resources about detecting and reporting sexual abuse in nursing homes include:

You can find a number of publications online offering guidance, including:

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