TRAVERSE CITY -- Several residents of a local nursing home suffered repeated physical and sexual abuse at the hands of their fellow residents in 2006-07, a pattern of violence that nursing home management failed to stem or report, state officials alleged.
Abuses uncovered at Tendercare Health Center-Birchwood, 2950 LaFrainer Road in Garfield Township, resulted in fines and prompted an ongoing criminal investigation by the Michigan Attorney General's office.
Victims included both male and female residents at Birchwood, which in November was named to a federal government list of the nation's most troubled nursing homes.
Some residents who allegedly targeted their neighbors no longer live at the roughly 140-bed nursing home, though others remain, a state official said.
Ellen Miller lived at Birchwood for just more than a year, until November 2007, and knew several residents who were harassed and assaulted. Nursing home employees didn't prevent aggressive patients from striking time and again, she said, an allegation backed up by state reports.
"I wouldn't send a dog there," said Miller, 68, of Bear Lake.
More recently, state regulators cited Birchwood for problems with patient confidentiality, incomplete medication records, improper care for bedsores and not preventing residents from falling. The nursing home was fined nearly $38,000 in 2007-08 for violations stemming from bedsores, falls and assaults on patients.
Birchwood is owned by Milwaukee, Wis.-based Extendicare Health Services Inc. Officials at Birchwood and its parent organization refused to discuss the nursing home's troubles.
Company officials issued a written statement to the Record-Eagle in which they made no reference to patient assaults and failed oversight. Instead, they cited a 2008 family and resident survey in which 97 percent of its 65 respondents said they were overall satisfied with the facility.
Vulnerable residents assaulted
Miller moved into Birchwood in November 2006 while she underwent rehabilitation and physical therapy following a leg amputation. She warned a male resident who sexually assaulted her neighbors that he'd have to pick himself off the floor if he laid a hand on her.
He never touched her, but others fell victim to assaultive residents. Miller witnessed what she believed to be an attempted assault of a woman disabled with Down syndrome.
"She had been abused before, and this guy used to pick on people who weren't able to voice their concerns," Miller said. "She couldn't express herself."
Michigan Department of Community Health personnel inspected Birchwood in July 2007 and found an extensive history of physical and sexual assaults dating to 2006.
Nursing home staff didn't investigate the incidents as abuse or report them to the state, records show. Inspectors said Birchwood employees neglected to protect the residents, often leaving them to fend for themselves.
Some men groped and grabbed women who couldn't physically defend themselves. One man exposed his genitals; another touched women's legs while he sat next to them playing bingo, said Miller, who recalled such incidents after being contacted by the Record-Eagle.
Birchwood residents were not willing to speak with a reporter; one said she and other residents feared retaliation from nursing home staff.
Residents also didn't report the abuses to Nancy Turner, the local long-term care ombudsman at Citizens for Better Care, a nonprofit advocacy agency.
Turner makes unannounced visits to area nursing homes and provides help and information to residents and their families. She said she didn't know of the abuses until the state report came out in late July 2007.
It's imperative for nursing home residents and their families to speak up if they know of abuses, Turner said.
"If people are for some reason afraid to report something, they can always call the ombudsman even anonymously ... and then we can get to the proper departments to get things investigated or dealt with immediately," she said.
'They neglected to investigate'
State officials found that nine female residents were sexually harassed and/or assaulted by five male residents. One of the repeat sexual assault victims also was physically attacked multiple times, state documents show.
At least three other residents, including men, were physically assaulted by fellow residents.
Nursing home staff recorded most of the incidents on residents' personal history charts, but did not report them to state regulators or local law enforcement.
"Despite the facility's knowledge of residents with a history of sexually aggressive behaviors and of ongoing sexual and physical assault of several facility residents, they neglected to investigate and report these incidents and to intervene to protect facility residents from the pervasive and continuous abuse/assaults being perpetrated on a regular basis," the Department of Community Health report stated.
The state Attorney General launched a criminal investigation in August 2007 after receiving referrals from the Department of Community Health about resident-on-resident abuse, said Attorney General spokesman John Sellek. The probe nears completion, he said.
"It's more looking at the management of the home, to see if any alleged situations, if they happened, if they were handled properly, if they took steps to try to rectify them," he said.
'Do I matter to anyone?'
The report detailed several attacks from a 71-year-old male resident with dementia, behavior disturbance and "high-risk sexual behavior."
A female resident told inspectors the man grabbed her breast while she was in the hallway. She said the facility's social worker told her she needed to watch how she spoke to men, "because some of them might consider it an invitation."
"That's like telling me if I'm a little girl in a pretty dress that I'm asking to be raped," the woman told state inspectors. "I'm not stupid. They should have stepped in and protected me. They should have stood up for me. Do I have no rights? Do I matter to anyone?"
The man also targeted a 52-year-old woman with Huntington's disease, a neurological disorder. The woman's chart indicated the man molested her five times.
One time, the man was found in bed with the woman. He was clothed, but the woman's pants and underwear were around her thighs. She said "He hurt me," according to the woman's chart.
The man lived in the section of the nursing home reserved for residents who require additional care and supervision. Employees later moved him to a different wing because residents there were more alert and could better defend themselves, according to the state report.
"They thought residents would handle themselves, and that's really not the residents' role. They're there to protect the residents," said Alice Turner, director of nursing home monitoring for the Department of Community Health. She is not related to Nancy Turner from Citizens for Better Care.
A 70-year-old male resident with schizoaffective disorder committed at least 13 physical assaults over a three-month span in 2007, nursing home records show. Most attacks were violent, unprovoked and involved repeated punches to the face or head, documents showed.
State inspectors asked Birchwood Administrator Kim Kloeckner if she investigated those incidents.
Kloeckner, the report stated, told state officials she didn't think incidents involving a man with dementia needed to be investigated or reported as abuse. She refused to discuss the assaults with a Record-Eagle reporter.
"We've taken every precautionary measure and put it in place and trained the staff," Kloeckner said.
More than they could manage
Birchwood may have had "more behavior problems than they could manage," Alice Turner said.
"I'm not making excuses ... but the facility did have a mental health unit and most of the perpetrators had mental health problems or dementia, so they had taken on a difficult group of elderly," she said.
Psychiatric and behavioral disorders are a growing problem for nursing homes because of the lack of specific mental health facilities, Alice Turner said.
"Whenever you have that many psychiatric behaviors together, you can see an escalation in problems, even in facilities that only have one or two," she said.
More area nursing home residents seem to have aging and behavior issues like dementia, said Nancy Turner, from Citizens for Better Care.
"What we need to see is better training on how to deal with those issues, because there are ways to deal with those issues, but a lot of times staff are not trained," she said.
Families not notified
Nursing homes are required to notify residents' families of significant incidents, but Birchwood didn't do so in the assault cases.
The Department of Community Health contacts residents' physicians if they're found to have received substandard care. The state doesn't individually notify residents' family members, but families are supposed to have access to reports posted in nursing homes.
Birchwood was ordered to complete training for abuse prevention. In addition to thousands of dollars in fines, a federal agency imposed Medicare and Medicaid sanctions for one month, and banned Birchwood from conducting a nurse aide training program for two years.
Birchwood in November 2008 became one of about 135 Special Focus Facilities in the nation, a federal designation for nursing homes with a pattern of serious problems in the previous three years.
Such nursing homes are inspected at least twice a year, more frequently than at most other facilities.
Birchwood has shown progress since November, and it can graduate from the list if the improvement continues for a year. Facilities that don't change can lose their ability to participate in Medicare and Medicaid.
Nursing home staff members have had extensive training, and there haven't been any reported incidents of abuse since the state inspection in July 2007, Alice Turner said.
Birchwood discharged four residents who were considered abusers, but Turner didn't know when or why. She said two of those accused in assault reports continue to live in the facility, including a man who, according to the state report, committed at least four sexual assaults over four months in 2007.
'Nothing but best of care'
Family members of some current and former Birchwood residents said they weren't aware of nursing home abuses until contacted by the Record-Eagle.
Pamela Hamstra's mother, father and aunt spent time at Birchwood. Hamstra said she's never seen a nursing home where residents get as much love and care as they do at Birchwood.
"What you have to realize is you're dealing with a place that is full of dementia patients that don't remember their spouse, don't remember their family," said Hamstra, of Traverse City. "You don't have enough staff."
Hamstra's mother, Roseannah Keith, stayed at Birchwood for a little more than a month, and Keith's husband lived there for more than seven years.
"I had nothing but the best of care. They're very caring and knowledgeable," Keith said. "The place is clean and the staff is well-educated. I just can't find a thing wrong with it."
Keith knew nothing of the assaults at Birchwood.
"I think it's terrible," she said. "I can't believe it and I won't believe it."
Residents and family members need to know their rights, said Nancy Turner.
"The main thing is we need to be open and talk about this," she said. "We have strategies for helping residents and families if they're not getting the care they need or if the quality of life is not what they would like."
