Investigating Sexual Assault in Nursing Homes
Is sexual assault in nursing homes being overlooked? This serious issue demands attention and action. In this week’s episode, nursing home abuse attorney Rob Schenk welcomes guest Casey L. Gray to talk about the critical steps in investigating sexual assault cases in nursing homes.
Schenk: Investigating sexual assault cases in nursing homes. Stick around out there.
Welcome back to the nursing home abuse podcast. My name is Rob. I will be your host for this episode. We’re going to be talking about sexual assault in nursing homes. What makes these cases different from other types of nursing home cases? What are the challenges? How do they come about to tip who the typical perpetrators are?
And we don’t do that alone. We have the fantastic Georgia trial lawyer, Casey Gray on the show to talk to us about these types of cases. All right. So let’s get into the meat and potatoes of the episode. We are going to welcome into the show, Casey Gray. Casey Gray is a trial attorney at the Helms Law Firm here in the state of Georgia, and they specialize in nursing home abuse cases.
Casey Gray specifically is a nationally recognized leader for elder rights. She’s a frequent speaker at attorney conferences, teaching how to effectively prosecute nursing home abuse cases. She is a passionate advocate. Who’s practice focuses on nursing home abuse and neglect cases.
And I am so happy to have her on today. Casey, welcome to the show.
Gray:
Thank you.
Schenk:
It’s so funny to be talking to you like this. Because usually we’re just on the phone blabbering to each other about cases and things like that. This seems to be much more of a formal environment than either of us are used to in our communications, but I thank you for coming on, especially given the topic.
So. I know that, my firm handles sexual assault cases in nursing homes and long term care facilities, but I find you, specifically, to be an expert at this. So that’s why I wanted you to come onto the show today and talk about this particular breed of cases. We’ll just basically take it from the 40, 000 foot view and then we’ll just get granular after that.
What are some signs of sexual assault in nursing homes?
But for you and your experience, and you’ve handled a lot of these types of cases, what are, for the families of loved ones in nursing homes, what are some of the signs, like the observable signs of a lay person can see of sexual assault that’s happened at a nursing home?
Gray:
A huge thing is just change in behavior and that’s the water trauma, but with sexual assault, a lot more. They’re more agitated. They’re more fearful of people caring for them. Some actual residents become hyper sexual and they start being overtly sexual with people. The big thing is that they, the behavior changes, your loved one, if this is normal for them, even if they have dementia, even if they have issues where they don’t function and can’t really tell you how they’re feeling, if this is a normal thing for them to start yelling and cursing at staff, or if it’s normal for them to start just taking their clothes off or being, making advances at other people.
And so the big thing is really watching their behavior. A lot of them get withdrawn and sad. A huge indicator is when they start having issues with people changing their briefs, people being in the bathroom. And it’s important to recognize that because at that point, there needs to be some kind of care in place.
So they don’t get triggered by things that have already happened, but also to make sure that you’re listening to them. You’re letting them communicate. Now there’s the obvious signs, the physical signs, bruises around the genitalia, around the private parts, sores or burns, those kinds of things, and those are, more overtly, but most of the time you’re not going to see that.
You’re just going to see uncontrollable crying if they can’t really communicate, or you’re going to see fear of a certain opposite sex staff member, but usually there’s something behind that, and so a lot of times people just count it first off as who would do that? When you really think about it, no one wants to think about their grandparents having sex to start with, much less someone wanting to sexually abuse them.
And so in your mind, you can’t fathom that anyone would even find your grandmother essentially desirable, especially these young staff members and things like that, but it happens. It happens a lot. And it’s usually caregivers that do it. And so watch them and their interaction. But really, it’s just a matter of everyone’s a little different, and behaviors, appetite decreasing.
All of these things are signs something’s wrong.
Schenk:
It’s interesting that you say that because I think many people might be under the misapprehension that they would need to be some type of sexual violence, sexually violent expert to understand if something’s going on oh, let me understand bruising around the genitalia.
Let me do an observation or whatever. But from what I hear you say, it’s true. If you know your loved one’s baseline, if you know how they behave normally, and then you observe the change in that based on the change in behavior, that’s going to be oftentimes the indicator to you that something has happened, being withdrawn, being more scared, being more of early sexual.
These things that if they’re not on the baseline could indicate something and you don’t have to be an expert. You don’t have to be a police officer to understand that something potentially has happened. And I think that’s an interesting, that’s an interesting observation that’s something that’s important for us to understand.
Gray:
I would argue too, though, you are an expert because the expert on your parents. Or your grandparent or your loved one. You know them better than anybody. And when other people may try to dismiss it or say, Oh that’s just normal with dementia. That’s normal with this type of behavior.
It may be normal in some sense. like circumstances, but, your loved one, like you’re that expert, what, when there’s something wrong and so really seeing that change in behavior and then investigating from there, that’s really the biggest part. And a lot of times, even people with dementia, They’ll tell you in their own way.
I’ve got two cases now where two people with dementia clearly said, this person hurt me and pointed to where they hurt them. They said the name, you match it up with the record. There is someone in that facility with that name and you have to believe them. Don’t dismiss it as dementia. It’s important.
Because a lot of people, especially people who aren’t amended, who don’t have these issues they’re embarrassed and they’re mortified and they would never tell. And so you’re, a lot of times you’re not going to get that disclosure. No one’s going to tell. You have to watch and prod and get behavioral health there and have them talk to your loved one and see what’s going on.
Something happened and the nursing home should be picking up on it. And they should be. Bringing behavioral health in and they should be calling you and saying, hey, something’s wrong. They’re not going to do it. Oftentimes they dismiss it as a symptom and it was not there before. I will say too, I think it’s important in what I’ve read and what I’ve seen in my records, that change is not going to happen immediately after the assault.
So saving like any kind of PTSD kind of stuff. It takes a little while for it to take. I usually see in the records I have and some of the reading I’ve done, usually around a month, three weeks to a month. That’s when that behavior starts changing after that very first assault.
What types of evidence do you use in nursing home sexual assault cases?
Schenk:
I see.
That’s an interesting point. Now, you mentioned records. I’m assuming that you’re meaning the chart. So in terms of sexual assault cases that you handle, what types of evidence are you trying to get your hands on to prove your case or that shows the sexual assault happened or the ramifications of it are happening?
Tell me about that. What are you looking for?
Gray:
So first and foremost, of course, we get the medical chart, right? But you also want to, you have your expert look at that until you, you can read the chart yourself. You can see when they know she was eating 80 percent of her meals.
She was eating 90 percent of her meals. She was pleasant, cooperative, and then suddenly everything changed. You can see that shift, but also it’s important because a lot of times they’re not going to document what happened, nursing homes, sick people. I don’t want to put them all in this branch, but a lot of them are going to ignore it.
And so you have to go outside of that. I get the 911 calls for the entire time the resident was at the facility, because that can give you a highlight on how many people are fighting, how many assaults are occurring, how many times they call 911. I go to Georgia Medicare and I get all of the complaint investigations.
I get all of the deficiencies. I look at that. You go, police departments, you ask for any kind of report from this. facility. You specifically ask about this person. If you think you know who assaulted your loved one, then you start doing criminal background checks and you ask the police department to give you any incident reports.
And so you just really have to get down and dirty with it. And you have to go to the federal government to get the complaint investigations. A lot of times I look at their files. If they’re fined a lot of money, something bad happened. And ProPublica is a great place to go to because ProPublica has a website, Nursing Home Inspect, and anyone looking at any kind of nursing homes can go look and see what their worst thing they did the last three years was.
And honestly, I’m still doing it in one case and you and I were just talking about this. In this case, my client’s guardian suspected something was wrong. She knew no one was really believing. And she started carrying a tape recorder in her pocket. It’s amazing the things that I’m finding.
Obviously, you gotta look at your laws and your state, you gotta look at the rules, but without her and documenting, she emailed, I got all the emails from my clients, the two, the administrator. I got body cam through from the police when they came to investigate once it was reported. It’s a huge long haul, but you should do all that before you can fall.
You can help it.
Schenk:
I feel like this, what you’re describing, is truly the distinction between a sexual assault case in a nursing home and a medical based situation nursing. I’m like a pressure injury or a fall. There’s so much beyond the chart that you need to prove your case.
Gray:
Because very rarely is going to be in the chart. And oftentimes the chart is just going to be wrong. And you will find that it’s either covered or it’s glossed over and there are no reports and there are no, there should be incident reports. There should be something to show. Hey, this person said someone hurt her or him. And here’s what we sent to the state.
You’re not gonna find those. And if you don’t go and do your own investigations, I’m even as far as checking to see if all the assaults they’re checking. Even if you post it on social media, it is great. Now you have to talk, you have Facebook, get out there and say, hey, does anyone else been hurt here?
I think it’s important that, as a community, it’s a lot harder to hide stuff whenever we all work together, because we weren’t in the right thing and we think justice should be served on these people and put it out there, ask for help from other people, and especially talk to residents.
If some residents from the facility, we’re going to Or prior staff, people who were there when your loved one was there, but are now gone, they are a gym of information because most of them, the good ones, and most of them are good people. They hated what was happening and they couldn’t talk about it because they threatened their jobs and their health insurance line, but when they leave, they’ll tell you more.
Schenk:
No, I was, I’m listening.
Gray:
That’s really, it really is just a matter of playing detective. But now for people. Who, aren’t lawyers, not trying to build a case. They’re really just trying to say, Hey, my mom was assaulted and I want something done about it. Just talk to your mom, ask her if anyone else knew, ask questions demand that they get a sexual assault nurse in there to talk to her, demand a rape kit, because these things are supposed to happen.
The regulations and laws require them to do it. They don’t. And so you have to be an advocate and just demand, send my mother to hospital. Get a SANE nurse. You do not interview her. You don’t talk to her about it. You don’t talk to my dad. I want a SANE nurse. And that SANE nurse is a sexual assault nurse.
They’re the experts and they know how to speak to people. Because if you let the nursing home nurses with no training do this oftentimes it’s Not only does it embarrass your loved one or make them scared to report, but it also clouds the facts and it makes it a lot harder to finally find out what really happened.
How to approach a sexual assault case in a nursing home?
Schenk:
Tell me about the the concept of injury or damages in a sexual assault case in a nursing home case, because it seems to me that a lot of the defense to these cases is we can never know how this alleged assault affected the resident because of cognitive impairment because they passed away, et cetera.
Like, how do you approach it? How do you approach that?
Gray:
You can because you look at the facts. In the case I have, my client was sexually assaulted within the next six months. She lost 40 pounds. No explanation. You see quickly that these, they decline. They become more withdrawn. They become more isolated.
And when people isolate themselves and become more depressed and become more withdrawn, they’re not fighting to get better. They’re not fighting to heal from infections. And you’ll see it’s a lot harder for them to survive for a longer period of time. There are so many instances where even if they aren’t suicidal, although most, a lot of ’em are.
Their physical well being is injured, but it’s not just that one of the biggest things about nursing homes that they’re required to do. And I think if anyone should have this dignity and this quality of life, it is our parents, our grandparents, they put the work in, they put the time in, and you’ve taken their last few years and you’ve made them miserable because all they have is a memory of someone violating them, hurting them.
And, you think about it. Anyone who’s been sexually assaulted, that sticks with you. And it’s a lot harder, especially for people from a generation that we’re not from the boomers and the silent generation, they don’t talk about these things. They don’t talk about sex. And so they live with this themselves and they just, you ruin their next few years, if they even make it that long.
What advice do you have for families of nursing home residents that suspect a sexual assault has occurred?
Schenk:
You had talked about a resident representative recording conversations. And again, obviously understand what the laws are in your state, but what are some other things that you mentioned, maybe getting a demanding a sex assault nurse? What are some ways that the family can get involved if sexual conduct, inappropriate sexual conduct or sexual assault has to, you think has taken place?
Gray:
First just to stick with the recording, I think everyone should petition their government to allow nanny cams in nursing homes. That would say so many elderly people, so much shame and heartbreak and neglect. There are very few sites that do it, but the things that could save and, a perfect example.
We don’t know what happened in that room, but if there was a camera and you were allowed to put it in there, we would. My creator had a case where a war veteran neglected the record show. They did everything right, but the family had a camera and that camera showed that they treated him horribly and let him die in his last few moments.
Schenk:
Yeah, I’m actually petitioning to get him on the podcast to talk about that case.
Gray:
Yeah, it’s amazing. Yeah. Petition and lobby your government, write letters, it really starts. And even, at a home base, go to the nursing home, the owners. Start a petition, go online, social media, TikTok, Facebook, whatever you use, and demand that these nursing homes, if they’re not going to allow you to put your own nanny cam in there, then every room, somehow, you need to be able to see what happens.
And I know there are issues with privacy, but the health and safety of our elderly and our loved ones are so much more important. Obviously if they are cognitive and can, they need to consent. But, the biggest problem is a lot of the people in the nursing homes who get sexually assaulted are those who don’t have the cognitive ability to say no.
Sometimes you even find that they actually believe that the staff member, this person loves them, they’re in a relationship, and it’s horrible abuse. And it’s a crime. But no, they’re not prosecuted. That just goes back to the other thing that relatives can do. Yes. Keep up with the police. Fight with them.
Tell them you want something done. Do not just trust that they’re going to follow the case. And it’s not, I’m not talking about police, everyone, it’s a hard subject, no one’s really adequately trained on it. And officers don’t really know how to investigate it, especially with someone with dementia.
You have nursing home nurses who have no idea what to do with it. And so people just don’t know what to do, but you have to stick with it and keep being the voice for your local.
Schenk:
I think it’s interesting what you said about it. It’s almost like crowdsourcing knowledge. Meaning going on Instagram and saying, hey, this has happened.
Has this happened to anybody else? I guess my only asterisk to that would be to make sure that whatever you say is truthful, or you have evidence to support it. Otherwise you might get in trouble. But I guess I hadn’t thought about that.
Gray:
You don’t have to say what happened. You literally can go and say, so I’ve heard some things.
Did anything happen to anyone at this facility? You don’t have to name names and say what someone did. It literally is a question. And I do think the more we talk about it and the more we put it out there and the more accountability we make these nursing homes have, the better it’s going to get because they’re going to start holding their staff.
Who are the primary perpetrators of assault in nursing homes?
Schenk:
Exactly. Okay. So in your experience and does this have an impact on the case, but who predominantly, is it the caregiver or is it predominantly in your experience, other residents that are doing the assault?
Gray:
80 percent of assaults are by caregivers and 70 percent of those are nursing homes.
Schenk:
I see. It’s almost, yeah, eight to eight to her. Yeah. Right.
Gray:
Now, what I have is an equal mix, but there’s usually, I have a case where a resident was first assaulted by another resident, received no counseling, no treatment, no trauma informed care. And it was almost put up like, oh she has a brain injury and she has dementia, so she can’t, she didn’t feel it.
That’s just not true. And then later on, she became the perfect victim for a staff member who honestly still has his license and has not been held accountable. So hopefully that’ll happen soon.
Schenk:
Wow. Okay. Casey, so much for coming on the show and sharing your knowledge with us. This has been absolutely fantastic.
And again, it’s weird for me to be talking to you with the suit on with questions and such, cause we usually were, gossiping or spreading rumors about things we probably shouldn’t, but anyway, thanks so much.
Gray:
Thank you so much for having me on Rob. I really appreciate it.
Schenk:
Thank you. Folks, I hope that you enjoyed this particular episode. If you want to get in touch with Casey Gray over at the Helms Law Firm, you can email her at caseygray@helmslaw.com or pick up the phone, call (912) 289-0655. Again, (912) 289-0655.
New episodes of the Nursing Movies Podcast come out every week. If you have a suggestion for something that you want me to talk about or a guest that you would like to hear from, please be sure to let me know. And with that folks, we’ll see you next time.
Thanks for tuning in to the nursing home abuse pod. Nothing said on this podcast, either by the host or the guest should be construed as legal or medical advice, nor is intended to create an attorney-client relationship between the host or their guests. New episodes for now are available every other Monday on Spotify, Apple Podcasts, or on your favorite podcast app, as well as on YouTube and our website, nursinghomeabusepodcast.com.
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Guest Information:
- The Helms Law Firm X