rape

Some of the victims can’t speak. They rely on walkers and wheelchairs to leave their beds. They have been robbed of their memories. They come to nursing homes to be cared for.

Instead, they are sexually assaulted.

The unthinkable is happening at facilities throughout America: Vulnerable seniors are being raped and sexually abused by the very people paid to care for them, a CNN investigation has revealed..

It’s impossible to know just how many victims are out there. But through an exclusive analysis of state and federal data and interviews with experts, regulators and the families of victims, CNN has found that this little-discussed issue is more widespread than anyone would imagine.

Even more disturbing: In many cases, nursing homes and the government officials who oversee them are doing little — or nothing — to stop it.

“At 83 years old, unable to speak, unable to fight back, she was even more vulnerable than she was as a little girl fleeing her homeland. In fact, she was as vulnerable as an infant when she was raped. The dignity which she always displayed during her life, which was already being assaulted so unrelentingly by Alzheimer’s disease, was dealt a final devastating blow by this man. The horrific irony is not lost upon me … that the very thing she feared most as a young girl fleeing her homeland happened to her in the final, most vulnerable days of her life.”

Maya Fischer made this statement in court at the 2015 sentencing of a nursing assistant convicted of raping her mother. Choking back tears, Fischer detailed her mother’s story — recounting how she had fled Indonesia as a youth with her family to escape the rape and killing of young girls by Japanese soldiers, only to fall victim decades later to a man whose job was to care for her.

A fellow caregiver saw male nursing assistant George Kpingbah in 83-year-old Sonja Fischer’s room at 4:30 a.m. on December 18, 2014, at the Walker Methodist Health Center in Minneapolis. A bare leg was on each side of his hips, and her adult diaper lay open on the bed. When the witness noticed the 76-year-old aide thrusting back and forth, she said she knew a sexual assault was occurring.

Kpingbah ultimately pleaded guilty to third-degree criminal sexual conduct with a mentally impaired or helpless victim and was sentenced to eight years in prison.

In court documents uncovered by CNN, prosecutors revealed it wasn’t the first time Kpingbah had been investigated over sexual assault allegations. Personnel records obtained by prosecutors during the investigation and reviewed by CNN show Kpingbah was suspended three times as Walker Methodist officials investigated repeated accusations of sexual abuse at the facility, including at least two where he was the main suspect.

The earliest complaint was in 2008, when police investigated allegations he had engaged in sexual intercourse with a 65-year-old who suffered from multiple sclerosis. In another case, an 83-year-old blind and deaf woman who lived on the same wing as Fischer’s mother said she was raped multiple times — always at midnight.

None of these allegations were found to be substantiated by the facility or the state. For years, Walker Methodist kept Kpingbah working on the overnight shift. Until that early morning in December 2014, when someone caught him in the act.

Walker Methodist refused to comment on the previous allegations against Kpingbah, who worked at the facility for nearly eight years, but said in a statement that it fully cooperated with authorities and that “the care and well-being of all of our residents and patients is our primary focus.”

CNN reached out to family members of other residents who earlier reported they were sexually assaulted at Walker Methodist during the time Kpingbah worked there (though he was not deemed a suspect in every case). They said the officials there were quick to dismiss the residents’ claims as hallucinations or fantasies.

The Minnesota Department of Health told CNN it is barred by state law from releasing the identity of anyone investigated over an allegation that has not been substantiated, regardless of the number of allegations.

ABUSE AFTER ABUSE

Some accounts of alleged sexual abuse come from civil and criminal court documents filed against nursing homes, assisted living facilities and individuals who work there. Other incidents are buried in detailed reports filed by state health investigators.

A 76-pound North Carolina nursing home resident who was so cognitively impaired she required assistance with even the simplest daily tasks reported that a nursing aide, behind closed doors, pushed her head toward him and forced her to give him oral sex.

The third time a resident of a Texas nursing home was raped by a nurse, the assailant ejaculated in the victim’s mouth and on her breasts. When he left, desperate to hold on to whatever evidence she could, she spit the semen from her mouth into her bra and kept the unwashed bra for three weeks. “That’s all I have,” she later told state investigators.

In Iowa, a woman who depended on a walker to move around and couldn’t bathe herself reported that a nursing aide sexually assaulted her in the shower. But the facility never flagged this accusation to authorities because the aide had left the country.

An 88-year-old California woman said she awoke in her nursing home bed with her catheter removed and her bed wet. The next thing she remembered was seeing an unknown male nursing assistant staring at her naked body. “This is why I love my job,” she remembered him saying, according to what she told police. Weeks later, the woman complained of severe vaginal pain and “oozing blisters,” and she was eventually diagnosed with incurable genital herpes. To this day, the identity of the alleged perpetrator hasn’t been determined.

And finally, in a small town in North Carolina, a nursing assistant continued working for years despite multiple reports of alleged abuse. Only after a defiant nurse reported the abuse to police was he fired and arrested. Luis Gomez, 58, is in jail awaiting trial and maintains his innocence.

Most of the cases examined by CNN involved lone actors. But in some cases, a mob mentality fueled the abuse. And it’s not just women who have been victimized.

For months, a group of male nursing aides at a California facility abused and humiliated five male residents — taking videos and photos to share with other staff members. One victim, a 56-year-old with cerebral palsy, was paraded around naked. Another, an elderly man with paralysis who struggled to speak was pinched on his nipples and penis and forced to eat feces out of his adult diapers. He was terrified his abusers would kill him. While the aides lost their certifications, an investigation by Disability Rights California found that many of them never faced charges.

Another group of nursing aides, teenagers in Albert Lea, Minnesota, tormented at least 15 male and female residents, many of whom suffered from Alzheimer’s. The female aides struck, poked and rubbed the residents and touched their breasts. They inserted their fingers into one resident’s rectum. They rubbed the residents’ crotches and laughed. One aide pulled down her own pants and sat on a female resident’s lap — humping and groping her. “I was basically appalled by the callous disregard for human decency,” a judge later said. Two of the abusers, who were 18 at the time and convicted of disorderly conduct by a caregiver, served 42 days in jail. The other teens were tried in juvenile court and faced no jail time at all.

Despite the litany of abuses detailed in government reports, there is no comprehensive, national data on how many cases of sexual abuse have been reported in facilities housing the elderly.

CNN surveyed the health departments and other agencies that oversee long-term care facilities in all 50 states. Of the states that could provide at least some data, the responses varied widely.

Illinois, for example, said 386 allegations of sexual abuse of nursing home residents had been recorded since 2013, 201 of which involved a caretaker. Hawaii said eight allegations of sexual abuse were investigated between 2011 and 2015 — five of which involved a caregiver. And when states provided a further breakdown of how many allegations had been substantiated, the results demonstrate just how few accusations end up being proven — whether it’s because of the extreme hurdles posed by aging victims, the destruction of evidence or half-hearted investigations by facilities and regulators.

Of the 386 cases in Illinois, 59 were considered substantiated. And in Texas, 11 of 251 sexual complaints in the 2015 fiscal year were substantiated. Wisconsin said it didn’t have a single substantiated report of abuse in the last five years.

But most states could not say how frequently abuse investigations involved sexual allegations, often stating that sex abuse allegations are not categorized separately from other forms of abuse.

The federal government doesn’t specifically track all sexual allegations either.

More than 16,000 complaints of sexual abuse have been reported since 2000 in long-term care facilities (which include both nursing homes and assisted living facilities),according to federal data housed by the Administration for Community Living. But agency officials warned that this figure doesn’t capture everything — only those cases in which state long-term care ombudsmen (who act as advocates for facility residents) were somehow involved in resolving the complaints.

The Centers for Medicare & Medicaid Services lumps sexual allegations into a category that includes all kinds of abuse, such as physical or financial. The agency said this is because it takes all forms of abuse seriously. When asked by CNN, the agency conducted a specialized search using sex-related keywords. But because not every case was sexual in nature, CNN had to review each case individually to filter out any irrelevant citations.

The reports show that 226 nursing homes have been cited for failing to protect residents from instances in which sexual abuse was substantiated between 2010 and 2015. Of these cases, around 60% resulted in fines, which totaled more than $9 million — though only 16 facilities were permanently cut off from Medicare and Medicaid funding. (Because the federal government only regulates nursing homes, this analysis did not include assisted living facilities.)

But these statistics only tell a small part of the story because they fail to capture the many instances in which nursing homes have been cited for mishandling allegations of sexual abuse in other ways — ranging from botched investigations to cover-ups.

Using inspection reports filed between 2013 and 2016 and a similar sex-related keyword search, CNN conducted its own detailed analysis.

The result: CNN exclusively found that the federal government has cited more than 1,000 nursing homes for mishandling or failing to prevent alleged cases of rape, sexual assault and sexual abuse at their facilities during this period. (This includes some of the cases provided by the Centers for Medicare & Medicaid Services.) And nearly 100 of these facilities have been cited multiple times during the same period.

Complaints and allegations that don’t result in a citation, which the government calls a “deficiency,” aren’t included in these Medicare reports. In addition, national studies have found that a large percentage of rape victims typically never report their assaults. So these numbers likely represent only a fraction of the alleged sexual abuse incidents in nursing homes nationwide.

Of the instances examined, at least a quarter were allegedly perpetrated by aides, nurses and other staff members, while a small portion involved facility visitors (including family members) or unknown assailants. And while most citations dealt with cases of residents abusing other residents, accusations made about caregivers and other workers tended to be far more serious, involving allegations of forced intercourse, oral sex, digital penetration and other forms of sexual assault.

The stories found in these reports range from sad to sickening.

An aide admitted to urinating in the shower while a female resident was inside it, showing her his erect penis and kissing her — then warning her not to tell anyone. A nurse overheard two aides talking about how a resident had been given a lap dance that made him ejaculate. A woman was found gagging and trying to fight off a male resident who had his penis in her mouth. Family members viewed video footage of an aide repeatedly raping their loved one, who was on feeding tubes, after hiding a camera in a stuffed animal in the room.

CNN’s analysis found that the nursing homes themselves are a large part of the problem. More than 500 facilities had been cited for failing to investigate and report allegations of sexual abuse thoroughly to authorities or for not properly screening employees for potentially abusive pasts. One nursing director told a state inspector that “if the facility reported all allegations it would be numerous and the State Agency wouldn’t want that either.”

An epidemic

It’s rarely talked about, but sexual assault in the very facilities tasked with caring for the elderly is hardly a new problem, with cases dating back decades.

It’s happening all over the country. In cities, the suburbs and the countryside. In nursing homes housing low-income residents on Medicaid. And in centers where people pay thousands of dollars out of their own savings to be there. They’re owned by huge corporations and regional chains but also by nonprofits and mom-and-pop small business owners.

And the issue is only becoming more pressing as the elderly population booms, with the number of Americans over age 65 projected to more than double between 2010 and 2050.

Yet the facilities that currently house more than 1 million senior citizens typically pay low wages to nursing assistants (about $11 or $12 an hour), making it difficult to attract and keep quality workers. And during the most vulnerable hours, the night shift, there are often few supervisors.

The abuse is “an epidemic,” said Mark Kosieradzki, a Minnesota attorney who has represented a number of victims and their families, including Fischer, the woman who recounted her mother’s rape in court. “Predators find elderly patients to be easy prey. Those patients often have dementia. They can’t say what happened, or are not believed because many people find it inconceivable that a 28-year-old caregiver would want to rape someone’s grandmother.”

Most sinister of all are administrators and employees who actively impede investigations.

“There are some situations where they don’t realize it’s happened, and they don’t want to believe it. They just don’t understand it,” said Ann Burgess, a well-known nurse and Boston College nursing professor who specializes in the assessment and treatment of elderly sexual abuse victims. “There are other cases where they try to cover it up. … They blame the victim.”

Even in facilities where there were no allegations of an orchestrated cover-up, documents examined by CNN showed a failure to preserve evidence. A resident who alleged abuse would be given a shower, for instance, or the crime scene might be disturbed by the washing of bedsheets. As a result, possible DNA evidence was lost.

Sometimes police and state investigators also fail to take complaints seriously. In one instance, a police report reviewed by CNN cited an administrator’s statement that the victim was an “avid viewer of the television show ‘Law and Order'” as a reason to dismiss her allegation. “Hallucinations seem to revolve around episodes of the series,” the officer wrote. As a result, there were no arrests, the rape kit was not tested and the case was closed.

The older the victim, the less likely an offender will be convicted of sexual abuse, according to a study of the elderly sponsored by the National Institute of Justice. And victims who lived in facilities were even less likely to see their assailants face charges and guilty verdicts.

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