Bill would raise nursing home awareness of patients’ fear of retaliation

It’s often just a little gesture — like an aide delivering a meal tray an hour late, or forgetting to recharge an electric wheelchair.

But for someone living in a nursing home who may have complained about the aide in the past, these actions can feel like retaliation.

Retaliation can take the form of a subtle gesture such as letting a meal go cold before serving it or more serious offenses such as withholding food or drink, said Nancy Schaffer, the state’s Long Term Care Ombudsman.

Either way, the fear of retaliation — whether real or perceived — is a big concern for those who live in nursing homes and depend on staff for their most basic needs.

As a result, Schaffer and other advocates are currently pushing a bill in the legislature to educate nursing home employees about this fear. The bill would require nursing home staff and management to go through training once a year to raise awareness of the fear of retaliation.

The bill is one of several nursing home bills this session, including legislation that would set up grievance committees in nursing home, regulate temperatures, and increase residents’ allowance for personal needs such as haircuts or snacks.

This is third year the retaliation bill has been proposed, and proponents are optimistic it has a chance this year because takes a no-cost, educational approach without any penalties. It would simply be added to annual in-service training the staff has to undergo anyway.

Brian Capshaw, who lives in an East Hartford nursing home, said he knows of cases where residents worried about repercussions for complaining about issues such as a lack of air conditioning.

“It’s a bigger problem than people think,” Capshaw said, adding, “There’s lot of little things that can make a resident kind of fearful of the person taking care of them.”

Oftentimes nursing home residents and their families try to ingratiate themselves in the nursing in hopes of staying on an employee’s good side.

“People as they become more dependent, they have greater concerns about retaliation. When you are more dependent on someone, you want to please them. You think ‘I want them to like me. I want them to be kind to me,’ ” Schaffer said.

And often nursing home employees are unaware of these fears and the impact of even the subtlest gestures.

In one case, for example, a nursing home employee had a rough morning trying to get her kids on the bus was not her usual gracious, cheerful self when she got to work. She was just having a bad day, but the nursing home resident interpreted her mood to be a form of retaliation.

“A lot of times the staff doesn’t even realize that people feel that way,” said Deb Migneault, legislative and community liaison for the Commission on Aging. “Their position as a caregiver puts consumers in a position where they don’t always feel they can speak up.”

The union representing nursing home workers supports the bill because it is aimed at workers and management and takes an educational approach rather than a punitive one. Last year’s bill had a last minute amendment that would have classified retaliation as a misdemeanor, which ultimately sunk the bill’s passage. This time the amendment is gone and the focus is purely educational.

“It’s something we think would be very helpful to training people to avoid these situations as opposed to try to ‘catch’ people,” said Deborah Chernoff, spokeswoman for Local 1199 New England Health Care Employees Union.

“It’s about building awareness and building empathy,” she said. “We’ve certainly heard residents express concerns that if they complain or their families complain that they will be retaliated against. Certainly it’s a vulnerable position to be in. There are issues of dignity and perspective and it’s important to remember that it is not a hospital, it’s somebody’s home.”

The legislation also has the support of the Connecticut Association of Health Care Facilities, a trade group representing 166 nursing homes and rehabilitation centers. Matthew Barrett, the group’s executive vice president, said the bill is reasonable and doesn’t put a financial strain on the nursing homes.

For Schaffer, the long term care ombudsman, the bill is the culmination of years of work. Her interest in retaliation began when she hosted an annual “voices” forum in 2005 and invited nursing home residents to speak freely about their concerns. She was surprised when both staff and residents reported seeing retaliation happening in nursing homes.

Realizing this was an issue, Schaffer commissioned the University of Connecticut study on retaliation, which found that 23 percent of nursing home residents surveyed indicated they would fear retaliation if they were to report an incident of abuse or neglect.

She subsequently developed a training curriculum for staff and a video featuring five nursing home residents who talk about their fear of retaliation. This fear is common in nursing homes across the country and several other states have requested copies of the video to use in their own training, Schaffer said.

Along with the retaliation bill, other bills affecting Connecticut nursing homes this session would:

  • Establish a grievance committee at each nursing home made up of one resident and two nursing home employees to review any grievances and ensure they are resolved in a timely manner.
  • Require nursing homes to keep safe and comfortable temperatures in rooms and common areas.
  • Increase residents’ personal needs allowance from $60 to $72.75 a month.