care home abuse case study

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Secret footage reveals abuse of woman with dementia at luxury UK care home

Exclusive: Family of Ann King, 88, hid camera in room at Reigate Grange in Surrey amid concerns about her welfare

‘Abuse, no other word for it’: nurse analyses footage

An 88-year-old woman with dementia was physically and mentally abused at a luxury care home charging residents close to £100,000 a year, the Guardian can reveal.

Staff misconduct was exposed by secret filming inside the home run by Signature Senior Lifestyle, which operates 36 luxury facilities mostly in the south of England.

It has admitted that Ann King was mistreated at Reigate Grange in Surrey earlier this year.

Distressing footage from a covert camera inside her room shows:

Care staff handling King roughly, causing her to cry out in distress. On one occasion she was left on the floor for 50 minutes.

King being taunted, mocked and sworn at when she was confused and frightened.

The retired nurse being assaulted by a cleaner, who hits her with a rag used to clean a toilet while she is lying in bed.

The cleaner threatening to empty a bin on the pensioner’s head and making indecent sexual gestures in her face.

The abuse was exposed by King’s children, Richard Last and Clare Miller . They became so concerned about her wellbeing at the care home, where she lived from January 2021 to March 2022, that they installed a hidden camera on her bedside table.

They have shared the footage because they fear what happened to their mother may not be an isolated incident, and because: “She has always been horrified by this type of thing and we felt she would have wanted us to show this is going on.”

Signature is described as the most expensive care operator in the UK by LaingBuisson, a market research company, and looks after more than 2,000 residents. It is owned by Revera, a Canada-based care company with more than 550 facilities worldwide, which in turn is wholly owned by a £150bn Canadian institutional pension fund investor. Reigate Grange is one of an expanding chain of luxury homes operated by Signature that promise “luxury living, exceptional care”.

Jayne Easterbrook, a nurse for 42 years and an expert in training care workers, described what she saw in the footage as abuse and said the carers were “aggressive”, “violent” and “in the wrong job”.

In one clip, when Ann was disoriented and asked “Where am I?”, a male care worker crouched down close to her face and said: “You’re in a fucking home.”

Surrey police were called to investigate the footage. The cleaner, an agency worker, admitted common assault in early summer and has been blocked from working for the care company.

One care worker has been fired, two resigned when confronted with the allegations, and one has been retrained. The manager of the care home at the time now runs another care home operated by Signature. It said it had full confidence in the manager as a “committed and values-driven home leader”, and that no investigations had identified concerns about their performance.

Signature apologised to the family and insisted the “reprehensible” behaviour was “committed by rogue individuals”. But the family believe it was the result of wider cultural problems.

The latest Care Quality Commission inspection report, published in April after King left the home, cut its rating from “good” to “requires improvement”. It found leadership was “inconsistent” and “leaders and the culture they created did not always support the delivery of high-quality, person-centred care”. Signature strongly denies the conduct was systemic or linked to the management of the home or organisation.

King is now being cared for at home by her daughter, but appears to have been affected by the experiences, which included having her bed shaken, being yanked into a sitting position by her pyjama top and shoved backwards into a chair.

“She has asked me to hide in the wardrobe to ‘stop the people coming in at night and hurting me’,” Miller said.

The recordings showed how carers responsible for checking her incontinence pads in the middle of the night rolled her roughly and restrained her, causing her to cry out in distress, and laughed while doing so.

As well as flicking King with the toilet rag, the cleaner aggressively fist-bumped her causing her to complain “You’re hurting me”, waggled his hips suggestively in her face and made a masturbating gesture at her.

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After the family showed Surrey police some of the footage he was interviewed under caution, admitted common assault and received a “community resolution” – an out-of-court arrangement.

On a separate occasion, a female care worker ignored King’s repeated calls for attention and turned up the music in her room which drowned her out. The footage also showed kind behaviour from other staff, and Last was keen to stress that other workers in the home were caring.

“When we saw this abuse it emotionally upset both of us and made us very, very angry,” Last said of himself and his sister.

There are around 900,000 people with dementia in the UK and demand is surging for specialist end of life care at a time when there are more than 160,000 social care staff vacancies.

King’s fees were £8,000 a month – more than three times higher than a typical local authority care home. Signature recently acquired two other chains, Sunrise Senior Living and Gracewell Healthcare. Reigate Grange has marketed itself as being akin to a luxury cruise ship and Signature has properties in affluent areas, such as Sonning, in Berkshire, and Virginia Water, in Surrey. It is building three new facilities a year, including on The Bishops Avenue, also known as “billionaires’ row”, in north London.

Signature has since offered an apology to King and her family, waiving £9,800 in outstanding fees and offering £5,000 in compensation “in full and final settlement of all and any claims” they may make about her care. The family has rejected the compensation.

Last, an electrician from Surrey, replied in writing: “My mum did not pay to get abused at your care home and the … poor care has made our mum suffer and us as a family.”

Signature pays care workers £12 an hour, £2.50 more than the average in England, and said it trains each worker in skills that include moving and handling residents, privacy and dignity, and dementia awareness.

A spokesperson for Signature said: “The behaviour of the individuals concerned was reprehensible, and fell far short of the standards of care we provide our residents every day. We would like to again apologise to Mrs King and her family, and reassure our community that these actions were committed by rogue individuals.”

When shown the footage by the family in May it said it alerted the relevant authorities and police, suspended the staff and removed the agency worker. It deployed an undercover supervisor and told other residents and families “that significant concerns had been identified at the home and encouraged them to report any concerns they may have to the council’s safeguarding team”.

“Separate independent reviews were also undertaken by the council safeguarding team and Care Quality Commission (CQC). The individuals no longer work for us and they have been reported to the Disclosure and Barring Service to prevent them working in care again. We will fully support any legal action taken against them.

“We remain committed to doing everything we can to deliver the highest quality care, and to ensuring peace of mind for the residents who make their home with us, and their loved ones.”

A surprise night time inspection by the CQC in March “prompted by information of concern” from several families, including King’s, Surrey county council and the local clinical commissioning group exposed “several risks to the residents”, said Deanna Westwood, a director of operations at the regulator. The inspection report found “risks to people’s safety and wellbeing were not always robustly monitored”.

Signature stressed the home was still ranked “good” in three out of five categories, and claimed the criticisms were minor and “easily addressable”. It said the CQC found staff “were aware of their responsibilities to keep people safe from the risk of abuse” and said “the actions of a few rogue individuals should not be construed as being representative of the wider staff team, or Signature as a whole”.

Surrey county council said it was “monitoring the provider” and reviewing information recently provided by the family, which the Guardian understands includes all the undercover film footage and other documents covering King’s stay at Reigate Grange.

• Social care
• Older people
• Private healthcare
• Care Quality Commission (CQC)

More on this story

UK care home where workers abused resident may face criminal action

‘I will always hear her screams’: family tell of heartbreak over care home abuse

‘Abuse, no other word for it’: a nurse analyses Reigate care home footage

Canadian owners of Signature care homes avoid UK taxes, researchers claim

Hidden camera reveals abuse by care home staff of dementia patient Ann King – video

Why global investors are piling into the UK’s luxury care home sector

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Abuse Stories

This collection contains all stories of abuse that have been featured in the Victim, Family & Caregiver Resources:  Neglect & Abandonment , Sexual Abuse , Physical Abuse , Psychological Abuse, and Financial Exploitation .

NEGLECT & ABANDONMENT

Abandonment by adult daughter.

Juliette, 87, lived with her daughter, Nanette, for the past 3 years.  Nanette helped Juliette with daily activities, such as getting her meals, bathing, and cleaning the house.  Nanette decided to move in with her boyfriend in another state and left her mother alone in the home.  About a week later, Juliette’s niece happened to be in town and stopped by to visit her aunt. She saw that the inside of the house was in very bad condition and found Juliette in poor health.  Juliette’s niece contacted Adult Protective Services (APS) and the State Area Agency on Aging. 

Neglect by Daughter and Son-in-Law

Kofi, 84, was diagnosed with Alzheimer’s disease and moved in with his daughter's family. Sometimes Kofi had trouble sleeping, had physical and verbal outbursts, and began wandering. His daughter and son-in-law were afraid that Kofi might wander out of the house if they left him alone.  They locked the doors to the house so that Kofi could not get out and wander around when they left for work.  A neighbor noticed Kofi trying to get out of the house. She contacted the local police and Adult Protective Services (APS).   

Neglect by Son and Daughter-in-Law

Tamara, 76, lived alone but had trouble getting around.  Her son and his wife asked Tamara to move in with them. Tamara had her own bedroom on the second floor and stayed there most of the time.  She could not use the stairs easily.  Her son and daughter-in-law both traveled frequently for work and sometimes neglected to give her adequate food and water.  They also failed to groom her or to clean her room consistently.  One day Tamara became dizzy, weak and disoriented so her daughter took her to the hospital. The hospital staff discovered that she was dehydrated, disheveled and obviously unwashed.  They asked about her care but Tamara said she was well cared for.   Nevertheless, as required by law, the hospital staff reported suspected neglect to Adult Protective Services (APS).  

Neglect by Sons

Clarence, 79, invited his two adult sons to move in with him so he would not be alone after his wife died. The sons soon sent Clarence out to live in the shed and locked him out of the house. Sometimes his sons put food out for him. Occasionally they gave him a basin of cold water with a washcloth. When one of Clarence’s neighbors noticed that Clarence seemed to be living in the shed, she called Adult Protective Services (APS) anonymously and reported what she had seen. She then decided Clarence may need immediate help so she called the police to do a welfare check.  

Abandonment by Guardian/Conservator

Henrietta, 88, required a court appointed guardian due to combined physical and mental disabilities that left her partially incapacitated.  Her niece, Roberta, was appointed as Henrietta’s guardian.  Roberta visited Henrietta in her home a few times but then never came back and made no further arrangements for her care.  A neighbor noticed the lack of activity at Henrietta’s house.  The neighbor knocked but couldn’t get Henrietta to answer door so she called law enforcement for a welfare check and Adult Protective Services (APS).  

June, 73, suffered a severe brain injury.  At first she was able to care for herself but as she got worse, a court appointed Sam as her legal guardian to assist her.  He saw June two times in the first six months but did not return to see June and did not arrange for her care.  He falsified reports to the court stating that he saw June every three months.  As a result, no one knew that June was living on her own without Sam’s help.  June was unable to remember to clean her house and the trash had not been taken out in many months.  Due to the deterioration of her house, June received a visit from a county health officer who discovered that June was very frail.  The county health officer was a mandatory reporter and called Adult Protective Services (APS). APS petitioned the court for a new guardian.  

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SEXUAL ABUSE

Sexual abuse by nursing aide.

Margaret, 77, lived in a nursing home that was known for good residential care.  One day, a nursing aide noticed that Margaret appeared anxious but Margaret would not explain why. While preparing her for a bath, the nursing aide saw multiple bruises on Margaret's arms, neck and back and asked what happened. Initially, Margaret did not say anything. Subsequently, the director of nursing learned from another resident that a new aide had sexually assaulted Margaret. As required by law, the director of nursing reported the sexual assault to Adult Protective Services (APS), and APS initiated an investigation, involving the Ombudsman and local law enforcement.  

Sexual Assault by Caregiver

Eduardo, 80, had a stroke.  His family hired an in-home caregiver to assist with his daily needs such as bathing and going to the toilet. One day his daughter stopped by to help see her Dad. As she helped him get dressed, he winced and she noticed that his genital area was red and irritated. Her father started to cry and mumbled something about the caregiver hurting him there. The daughter immediately called Adult Protective Services (APS) to make a report. She also called the agency where the caregiver worked, made a complaint, and ended services. APS alerted the law enforcement.  

Sexual Assault by Family Member

Pearl, 70, took her nephew in when his mother could not handle his behavior problems. The nephew began viewing pornography on the TV that he shared with his aunt. Pearl was uncomfortable about this and told her nephew to stop. One day, the nephew came home and was high on drugs.  He forced himself sexually upon his aunt. Pearl called 911 for local law enforcement and went to the hospital where she met with a sexual assault victim specialist.  

Sexual Abuse by Guardian/Conservator

Angela, 71, required guardianship because of her continued alcohol and drug abuse.  The court appointed Richard as her guardian.  Soon after his appointment, he gave Angela more drugs, sexually assaulted her, and threatened her with prison for her drug use if she reported him.  Angela summoned the courage to go the local police and contacted a lawyer to obtain a new guardian.  

PHYSICAL ABUSE

Physical abuse by adult grandsons.

Katherine, 82, raised two grandsons, Joel and Kent.  They had physically abused her since they were teenagers.  After 12 years in prison, Joel returned to his grandmother's home because he had nowhere to go. One night Joel came home and was drunk.  He banged on the door but Katherine told Joel to go away. After he entered the house through a back window, Joel beat his grandmother. Katherine went to a neighbor’s house and called 911. Joel was arrested and Katherine was taken to the hospital. The police contacted Adult Protective Services (APS).  

Physical Abuse by Disabled Adult Son

When George, 79, lost his wife of 50 years to cancer, his son, Lawrence, came to live with him. Lawrence was on disability due to a traumatic brain injury.  The brain injury caused behavior changes, including difficulty with self-control and verbal and physical outbursts.  The injury also caused violent mood swings. Occasionally, Lawrence went to a neighbor's apartment and got drunk. One night when Lawrence returned home, George asked him if he was drunk. Lawrence yelled "NO" and punched his father in the face. Because George was afraid of further violence, he called 911 to get help from the police.     

Physical Abuse by Spouse

After 58 years of marriage, Virgil and Ella, both 83, knew each other's habits well. Sometimes, when they argued they became physically violent. Nevertheless, they said they loved each other and had never considered divorce.  Violence was unfortunately a part of their relationship.  As Ella aged, she developed osteoporosis.  She began to worry that if she fell down when they were fighting each other she might end up with a broken bone. She confided this to a friend, and her friend suggested calling the local domestic violence hotline to speak with a counselor.  

Physical Abuse by Guardian/Conservator

Blair, 65, had no close relatives.  Because of early-onset dementia, he was placed in a nursing home and required guardianship.  Chris, Blair’s guardian, came to Blair’s nursing home every few months to see how Blair was doing.  During the last visit, Chris began slapping Blair to wake him up.  Joan, a care attendant rushed to the room when Blair began crying out for Chris to stop.  Joan noticed marks on Blair’s face and asked what had happened.  Blair was unable to tell Joan what had happened but Chris quickly left the room.  Joan reported the incident to her supervisors who helped her make a report to Adult Protective Services (APS).  The report triggered involvement by the state ombudsman and local law enforcement.  

Physical Abuse by Long-Term Care Aide

Monica, 79, was placed in a long term care facility when her ALS became severe and her family could no longer care for her.  Her family became concerned when they saw bruising on her arms and back.  Monica was not able to speak and could not tell her family how she got the bruises.  Monica’s family asked the staff about the bruising but was not satisfied with the explanation. The family also noticed that when a certain aide helped bathe her, Monica became upset and agitated.  They suspected that the aide was hitting Monica and called local law enforcement.  

PSYCHOLOGICAL ABUSE

Psychological abuse by daughter.

Zoe, 79, was healthy, independent and lived with her unmarried daughter, Trish, to share expenses. Zoe believed they had a good relationship. Nevertheless, Trish sometimes yelled at Zoe, calling her horrible names and telling her she was worthless.  Trish began threatening to put Zoe in a nursing home. Zoe tried to ignore these rants because she was grateful to live with her daughter.  However, she thought she deserved to be safe from such comments. Zoe eventually told a close friend about Trish’s yelling and threats.  The friend suggested that Trish and Zoe seek counseling and that Trish get respite help from a local Agency on Aging.     

Psychological and Physical Abuse by Spouse

Sarah, 75, had been married for over 50 years to Saul who was abusive.   The abuse had a pattern. Her husband would start following her around watching her every move.  Then he would make comments under his breath. Finally, he would start pointing his finger in her face and pushing her around.  Since Saul’s retirement, this pattern seemed to be getting worse and happening more often.  Sarah picked up a pamphlet on Domestic Violence at her synagogue and decided to make her first call for help.  From her conversation with the domestic violence advocate, she learned about resources in her area and steps she could take to be safe.  

Jane had not seen her friend Harry, 87, at Mass for weeks.  This was not like her friend since Harry went to Mass almost every Sunday.  Jane stopped by Harry’s house.  Harry answered the door and Jane was shocked.  Her friend had lost weight, looked terrible, and had obviously been crying.  Harry told Jane in a hushed voice that since his daughter had moved in she would not let him go to church, the senior center, or even out of the house.  Harry said that his daughter was now controlling everything including his money.  Before Jane could say anything, Harry’s daughter started yelling and Harry quickly closed the door.  Jane decided to make an anonymous report to Adult Protective Services (APS).  

Psychological Abuse by Guardian/Conservator

Mark, 75, had Alzheimer’s disease and was beginning to have severe memory loss and trouble walking around the house.  Mark’s paid caregiver, Yolanda, asked the court to appoint a guardian.  Each time the guardian, Mrs. McKee, visited with Mark, she made fun of his memory problems and inability to remember where he was or even who Yolanda was.  Yolanda became worried about Mark and the fact that Mrs. McKee, the court appointed guardian, did not seem to take Mark’s condition seriously.  Yolanda called Adult Protective Services (APS) and the probate court to review Mark’s guardianship.  

Psychological Abuse (cyber bullying) by Stranger

Rosie, 75, lived alone in an independent senior housing community.  Her next door neighbor, a disabled retiree, repeatedly emailed her rude messages and sent vulgar and threatening messages to her cell phone. Fearing her neighbor might harm her if she told him to stop Rosie contacted local law enforcement, and filed criminal charges as well as a petition for a civil restraining order. She also notified housing management.  

FINANCIAL EXPLOITATION

Financial Exploitation by Family, Close Friends, or Neighbors

Financial Exploitation (fraud) by Spouse

John, 68, and Bernice, 65, had a “second marriage.”  John worked as an engineer and Bernice stayed home.  Jointly, they had purchased 22 acres with a second home for their retirement. Trying to mend poor relationships with her sons from her first marriage, Bernice asked John to add one son to the property deed. He agreed. While John was on a business trip, Bernice faxed John the last three pages of the deed for his signature. He signed and returned the form. Unknowingly, he had signed a form deeding the entire property to Bernice who then “gifted” the property to her son. John contacted a lawyer.  

Financial Exploitation (identity theft) by Adult Child

Joseph and Malvina, both 80 and retired, had taken in their daughter after her release from prison. Soon after she moved in, the couple received one credit card bill for $8,347, another for $12,694, and a third for $10,012.  The couple had no idea their daughter had used their credit cards or that she had opened additional credit card accounts in her mother’s name. Now, Joseph and Malvina were faced with significant debt.  The couple’s other adult child contacted Adult Protective Services (APS), the credit card company and the Federal Trade Commission (FTC).  

Financial Exploitation (theft) by Guardian/Conservator

Monte, 82, had moderate dementia and required guardianship due to his worsening disease.  Unfortunately, Monte had never given his only son, Samson, Power of Attorney.  Monte also no longer had sufficient mental capacity to execute a power of attorney for Samson, who now lived out of state. Monte’s personal assistant, John, handled all of Monte’s financial transactions for him.  Samson was concerned about John’s access to his father’s finances and reviewed Monte’s account statements while visiting his father over the summer. Samson discovered that several times John had taken over $3000 from one of Monte’s little used accounts.  Samson contacted the investment firm, local law enforcement and Adult Protective Services (APS) for help.  

Financial Exploitation (misuse of a power of attorney) by Relative

Russell, 88, needed help managing his day to day affairs. His nephew, Jack was out of work and offered to come and live with Russell and help him while Jack looked for a job. Jack took his uncle to the bank saying he wanted to protect Russell’s money.  Russell told the bank teller to add Jack to his bank accounts.  Jack then downloaded a power of attorney (POA) form from the Internet and had Russell sign it.  With the POA, Russell’s credit card company added Jack as a second user to his credit card. When Russell's sister visited him, she asked about the situation.  Russell told her that he thought their nephew was stealing his money. She and Russell went to the bank and learned that Jack had spent a considerable amount of his uncle’s money.  The sister alerted bank officials, Adult Protective Services (APS) and local law enforcement. Russell filed for an emergency civil protective order to have Jack removed from his home.  

Financial Exploitation (theft) by Friend

Ya, 84, became friends with Michelle, 72, in a computer class at the senior center. Using her own computer, Michelle established an online account to help Ya pay her bills. However, Michelle wrote checks for some of her own bills as well as for Ya’s bills.  Ya was unaware that Michelle was writing checks for herself until she saw a returned check made out to a cell phone company. Ya didn’t own a cell phone.  When she checked her account, Ya discovered that most of her money was gone.  Ya contacted  local law enforcement and asked her bank to investigate.  

Financial Exploitation (promises exchanged) by Acquaintance

Barbara, 76, a retired high-ranking federal government employee, was independent and lived alone.  She was recently diagnosed with Alzheimer’s disease and knew she would need more help in the future.  Barbara asked Margie, a former neighbor, who was recently divorced, to move in with her. Over time, they agreed that Margie would care for Barbara in her old age and that in return, Barbara would provide Margie’s with food and housing.  Barbara gave Margie her power of attorney for access to all her accounts and named her the sole beneficiary of her investment portfolio. After a several months, Barbara noticed her accounts were almost empty and called local law enforcement which also notified Adult Protective Services (APS).  

Financial Exploitation by Trusted Professionals

Financial Exploitation (inappropriate products) by Investment Broker

Jackie was a successful investment broker.  She had a reputation for making her clients wealthy.  Recently Julio, 80, asked Jackie for financial advice.  She recommended investments that had high growth potential but were risky for older adults.  When Julio’s daughter reviewed his investment portfolio, she found he had investments that wouldn’t provide a return for 30 years and would do Julio little good.  Julio contacted the Commodity Futures Trading Commission (CFTC) to check the background of financial professionals, the Securities and Exchange Commission ( SEC) and Adult Protective Services (APS).  

Financial Exploitation (investment fraud) by Financial Advisor

Millie, 63, was a public school cafeteria worker who saved for retirement and wanted to help her grandson go to college. A friend recommended Tom, a polite, outgoing financial adviser. Millie didn’t understand the stock market but, after attending a retirement seminar, trusted Tom to invest her money. When she wanted to give her grandson money for college, Millie learned most of the money she had invested was gone. Tom had created fake account statements that showed Millie was making money.  Millie contacted Tom’s company and reported him to the Attorney General and Adult Protective Services (APS) in her state.   

Financial Exploitation (investment fraud) by Tax Preparer

Alex, an accountant, gave discounts for tax preparation to clients who were over age 65. He built a clientele of wealthy older single adults, widows or widowers, and found ways to get them tax refunds.  Many of Alex’s clients gave him Power of Attorney; he also served as their financial adviser. Upon request, Alex gave his clients a statement of their account. Otherwise, he called clients with good news about their investments or about tax loopholes that he took advantage of for the client. When a client’s son learned the deed to his father’s house was in Alex’s name, he looked into his father’s finances and discovered Alex controlled all of his father’s assets.  The client’s son contacted the Attorney General, IRS and Adult Protective Services (APS) in his father’s state.  

Financial Exploitation (forgery) by Professional Caregiver

Amarjit, 91, paid his own bills. When he opened his bank statement he noticed four $150 checks had been made out to his home health aide.  He knew he had not written or signed the checks. Amarjit contacted his bank and local law enforcement.  

Financial Exploitation (improperly obtained power of attorney) by Professional Caregiver

Roman, 84, was bedridden.  He hired Bob to provide caregiving services.  Soon after, Bob forged Roman’s signature to create a fake Power of Attorney (POA) that gave Bob the power to act in Roman’s place.  Using this illegal Power of Attorney, the bank allowed Bob to put his name on Roman’s savings and checking accounts.  Bob explained to the bank that Roman agreed to the change but couldn’t be present because he was bedridden.  Bob later put his own home address name on Roman’s accounts.  Roman became concerned when he stopped receiving monthly statements from the bank.  Roman contacted the bank immediately and local law enforcement.

Financial Exploitation (fraud) by Representative Payee

Carollee appeared to take good care of the older adults, including veterans, who lived in the group home where she worked. Because most of the residents were disabled and had no family to represent them, Carollee became the representative payee for their Social Security and Veteran’s Benefits. The regular postal carrier became curious when he started delivering over 30 envelopes from Social Security and Veteran’s Benefits to Carollee’s home each month.  He thought she lived alone so he notified the local postal inspector through the US Postal Inspection Service hotline, Veterans Affairs, and Adult Protective Services (APS).

Financial Exploitation (inappropriate product) by Mortgage Broker

John, 68, wanted to provide for his wife, Vickie, 62, and leave money for his children when he died.  He and his wife thought their home would provide this economic security after they both retired. Less than a year after his retirement, John had a massive stroke and died.  Vickie contacted a mortgage broker whose ad she saw in a local magazine.  The mortgage broker persuaded Vickie, who had been diagnosed with dementia, to sign a reverse mortgage on her house.  Vickie’s daughter learned of the transaction and contacted local law enforcement and Vickie’s mortgage lender.  

Financial Exploitation by Strangers

Financial Exploitation (internet identity theft) by Stranger

Naira, 71, was single, disabled and retired.  When she got an email from her bank requesting verification of her account numbers, Naira complied. Later she opened an email that she thought was from a government official investigating Medicare fraud.  The email asked her to provide her Medicare number to verify that there was no fraud on her account. When her bank manager called to confirm that she wanted to close her accounts, Naira learned the money in her savings and checking accounts was gone. She told the bank manager about the bank email and he told her that it must have been a scam. When she explained how she’d given her Medicare number after the second email, the bank manager contacted the Centers for Medicaid and Medicare, the Federal Bureau of Investigation and Adult Protective Services (APS).  

Financial Exploitation (fraud) by New Sweetheart

Arturo was a popular hair stylist. He was charming and attentive to widows and older women and often asked clients who seemed well-off out to dinner. During these meals, Arturo discussed his financial woes. Some customers gave him their bank account information and put him on their accounts “just in case.”  Arturo helped three of these wealthy women manage their real estate investments.  Two of them even made him a joint owner of their homes.  When one customer died, the executor discovered her bank and investment accounts were depleted, her home now belonged to Arturo, and heirlooms were missing.  The executor contacted Adult Protective Services (APS), local law enforcement and the FBI.  

Financial Exploitation (grandparent scam) by Stranger

Charlie, 82, received a phone call from a “sheriff” in New Orleans.  He said Charlie’s grandson had been arrested for intoxication. To be released, the sheriff said that someone needed to pay the grandson’s fine and that his parents were not home. The sheriff told Charlie to wire money to an online address. After the money was delivered, Charlie got a call from someone he thought was his grandson saying that he needed money to get home from New Orleans.  Charlie became suspicious when he asked the person claiming to be his grandson a few personal questions that he couldn’t answer.  The call ended amicably.  Then Charlie called a nearby Federal Bureau of Investigation field office to report the incident and filed a complaint with the FBI’s Internet Crime Complaint Center online.  

Financial Exploitation (home repair scam) by Stranger

At 83, Shirley, who was a retired lawyer now lived alone after the death of her husband.  It had become difficult to keep up repairs on her house. One day a handyman she’d never seen before rang her doorbell and told her the gutters on her house needed to be cleaned and that she might need a new roof.  Because she didn’t have anyone else to help her with these tasks, Shirley paid him $500 to clean the gutters and an additional $10,000 as a down payment for a new roof.  She never saw the handyman again.  She told a neighbor what had happened and the neighbor contacted Adult Protective Services (APS), local law enforcement, and the state’s consumer protection agency within the Attorney General’s office.   

Financial Exploitation (lottery scam) by Stranger

Armando, 78, was thrilled when someone from the lottery called to confirm he had won $10,000.  The person on the phone said that they would send the money after Armando sent a winner's fee of $500.  Thinking only about what he would do with the winnings, he wired the $500 “winner’s fee” to the address the caller provided.  Because he did not receive the promised lottery winnings after a month, he contacted the Federal Trade Commission (FTC).

Protecting Our Seniors From Abuse & Neglect

Recent Elder Abuse in Nursing Homes: Case Studies

Elder abuse is far more common than many people would like to believe. What’s worse, recent reports confirm that nursing home abuse skyrocketed during the COVID-19 pandemic. Help keep your loved ones safe by reading these recent case studies on elder abuse in nursing homes. Accepting that elder abuse is a real problem is the first step in preventing it.

Examples of Elder Abuse in Nursing Homes: A Nationwide Problem

Nursing home abuse happens when trust is violated through an act — or a failure to act — that harms an older person. It can include emotional, financial, physical, or sexual abuse as well as nursing home neglect.

Tragically, a 2020 report from the World Health Organization (WHO) estimates that roughly 1 in 6 adults 60 years old and over were the victims of elder abuse in nursing homes and other community settings.

Even worse, the WHO warns that this already alarming figure is likely to be too low since only 1 in 24 cases of elder abuse is ever reported.

Recent case studies on elder abuse in nursing homes show that this is, unfortunately, a nationwide problem.

The most common forms of nursing home abuse are:

• Emotional abuse : when an older person is yelled at, threatened, or belittled
• Nursing home neglect : substandard care of a nursing home resident
• Physical abuse : any form of violence that leaves an older person significantly injured, including cases of wrongful death
• Sexual abuse : any sexual contact with an elder who cannot give their consent

Thankfully, help is available if you or a loved one suffered nursing home abuse or neglect. Get a free case review to see if you can access legal compensation right now.

Get a free legal case review if you or a loved one has suffered abuse or neglect.

Examples of Case Studies on Elder & Nursing Home Abuse

1. suspected nursing home abuse in massachusetts.

After hundreds of 911 calls were made about suspected nursing home abuse, a criminal investigation is underway against an assisted living facility in Watertown, Massachusetts.

Several of the heartbreaking reports include:

• After responding to a call about a faulty ventilator, firefighters found that none of the electrical outlets in a resident’s room were working
• An injured nursing home resident was on the floor asking for help, but when firefighters asked the staff member in charge about it, she just laughed
• Firefighters found staff performing CPR on a man who had already been dead for hours

Further, in a case of suspected physical abuse at the same nursing home, the daughter of a dementia patient found her mother’s face severely battered.

“It was horrific. She had a huge gash on her forehead and a lump the size of a golf ball, her whole face was bruised.” – Daughter of Massachusetts nursing home resident

These examples reveal a widespread pattern of abuse and neglect by staff, which will hopefully be corrected. No nursing home resident should ever have to endure these hardships.

2. Nursing Home Sexual Abuse in Minneapolis

A male caregiver at a Minneapolis care facility was sentenced to eight years in prison for the rape of a nursing home resident with Alzheimer’s disease.

“My final memories of my mother’s life now include watching her bang uncontrollably on her private parts for days after the rape, with tears rolling down her eyes, apparently trying to tell me what had been done to her, but unable to speak.” – Daughter of sexual abuse victim

A follow-up investigation by CNN revealed that the rapist had assaulted multiple other residents, including those who suffered from mental or physical handicaps, before he was finally caught.

3. Nursing Home Neglect in Iowa

A nursing home resident in Iowa died after extreme neglect related to dehydration . The emergency room doctor believes she died from a stroke after not receiving any type of fluid for at least four to five days. The nursing home was fined $77,463.

Examples of Elder Abuse in Nursing Homes During the Pandemic

While nursing home abuse and neglect were already a very serious issue, the ongoing coronavirus pandemic made things even worse.

According to Human Rights Watch, neglect and isolation may be responsible for causing severe damage to countless nursing homes residents during the COVID-19 crisis.

Recent nursing home abuse case studies revealed:

• A resident in her 80s who was healthy and pre-pandemic died shortly after visitation stopped due to suspected malnutrition
• In less than a year, a dementia patient living in a nursing home went from 106 pounds to 82 pounds before being discharged and dying several days later
• A dementia patient in her 70s lost 20 pounds during the pandemic and developed painful bedsores on her buttocks and toes

Why Does Elder Abuse Happen in Nursing Homes?

Elder abuse in nursing homes is believed to occur for several reasons.

Nursing home abuse may happen due to:

• Understaffing
• Inadequate staff training, especially in dementia care
• Lack of supervision
• Staff burnout

No matter what the explanations for elder abuse are, it is never acceptable. All nursing home residents deserve to be free from harm and properly cared for.

How Common Is Elder Abuse?

Although there is a lack of concrete data, recent reports suggest that elder abuse is common.

It is believed that elder abuse is more likely to occur with nursing home residents than with older adults living in community settings. In fact, 2 in 3 nursing home staff members admitted to abusing or neglecting residents in the 2020 WHO report.

Common Signs of Nursing Home Abuse

The most common signs of nursing home abuse are physical symptoms and any type of sudden change in behavior.

Depending on the form, some additional signs of nursing home abuse may include:

• Bruising, scars, or welts seen on the body
• Mumbling, sucking one’s thumb, or rocking
• Unexplained STDs or other genital infections
• Bedsores, malnutrition, or dehydration

Get Help For Elder Abuse in Nursing Homes

If you or a loved one was the victim of nursing home abuse, you may be entitled to compensation. Money awarded in a nursing home lawsuit can help pay for medical expenses and bring peace of mind.

The Nursing Home Abuse Center is dedicated to helping victims of nursing home neglect, abuse, and wrongful death. Contact us now to find out if we can help you and your family.

The Nursing Home Abuse Center (NHAC) was founded to bring justice to those affected by nursing home and elder abuse. Our mission is to educate and empower victims of abuse and their families to take a stand against this unlawful mistreatment. We work to return dignity back to those who have been broken down by nursing home abuse and neglect.

• BMC Health Services Research. (2020). Elder Abuse And Neglect: An Overlooked Patient Safety Issue. A Focus Group Study Of Nursing Home Leaders’ Perceptions Of Elder Abuse And Neglect. Retrieved August 14, 2021 from https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-020-5047-4
• Fiandaca, C. (2021). I-Team: Watertown Long-Term Care Facility Investigated For Possible Abuse, Neglect. CBS Boston. Retrieved from August 14, 2021 https://boston.cbslocal.com/2021/02/12/long-term-care-facility-nursing-home-elder-abuse-investigation/
• Human Rights Watch. (2021). Us: Concerns Of Neglect In Nursing Homes. Retrieved August 14, 2021 from https://www.hrw.org/news/2021/03/25/us-concerns-neglect-nursing-homes
• Merrilees, A. (2019). '83 Years Old, Unable To Speak, Unable To Fight Back.' Daughters Share Heartbreaking Stories Of Abuse In Nursing Homes. ABC News. Retrieved from August 14, 2021 https://abcnews.go.com/Politics/83-years-unable-speak-unable-fight-back-daughters/story?id=61504444
• World Health Organization. (2021). Elder Abuse. Retrieved August 14, 2021 from https://www.who.int/news-room/fact-sheets/detail/elder-abuse

Caregiver abuses, tortures 93-year-old patient at nursing home in gut-wrenching video: report

A caregiver at a Michigan assisted living facility was hit with assault and torture charges for allegedly beating a 93-year-old woman in her care — with the abuse caught on surveillance video.

Dontia Shawnra Arrington, 26, was charged with vulnerable adult abuse, torture with intent to cause cruel or extreme physical and mental pain, and assault with intent to case bodily harm in the stomach-turning incident at the Landings of Genesee Valley facility, WNEM-TV News reported.

“You see the vulnerability of the victim and the fact that she’s getting hit with a 2- or 3-pound soiled diaper,” Genesee County Sheriff Chris Swanson told the outlet.

“But that isn’t enough. When she brought her hand across her throat in a chokehold, that can kill people, especially a 93-year-old.”

“This is severe dementia,” the sheriff added. “[The victim] has no idea what’s going on. She can’t process what we process on a regular basis.”

The video, captured by a nannycam placed at the facility by the victim’s relatives, appears to show Arrington flying off the handle after the elderly patient, who suffers from dementia, soiled herself.

The caregiver slams the woman with the dirty diaper then chokes her with her hand.

“I was appalled,” Genesee County Prosecutor David Layton told WNEM of the video.

“I was disgusted and I was very angry,” Layton said. “And I said to Chief Assistant [Genesee County Prosecutor Tamara] Phillips, ‘We’re gonna have to charge this woman as harshly as we can.'”

Arrington could face up to life in prison if convicted on all of the charges.

She was ordered held on a $45,000 bond and is due back in court on Thursday, the outlet said.

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How Nursing Homes’ Worst Offenses Are Hidden From the Public

Thousands of problems identified by state inspectors were never publicly disclosed because of a secretive appeals process, a New York Times investigation found.

Tammy Bowman and her husband. Ms. Bowman’s sister died in an Indiana nursing home that did not isolate residents suspected of having Covid-19. Credit... Johnathon Kelso for The New York Times

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By Robert Gebeloff ,  Katie Thomas and Jessica Silver-Greenberg

• Published Dec. 9, 2021 Updated June 22, 2023

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In Arizona, a nursing home resident was sexually assaulted in the dining room.

In Minnesota, a woman caught Covid-19 after workers moved a coughing resident into her room.

And in Texas, a woman with dementia was found in her nursing home’s parking lot, lying in a pool of blood.

State inspectors determined that all three homes had endangered residents and violated federal regulations. Yet the federal government didn’t report the incidents to the public or factor them into its influential ratings system. The homes kept their glowing grades.

A New York Times investigation found that at least 2,700 similarly dangerous incidents were also not factored into the rating system run by the federal Centers for Medicare and Medicaid Services, or C.M.S., which is designed to give people reliable information to evaluate the safety and quality of thousands of nursing homes.

Many of the incidents were uncovered by state inspectors and verified by their supervisors, but quashed during a secretive appeals process, according to a review of thousands of pages of inspection reports and nursing home appeals, which The Times obtained via public-records requests. Others were omitted from the C.M.S. ratings website because of what regulators describe as a technical glitch.

The Times this year has documented a series of problems with Medicare’s ratings system. Much of the data that powers the system is wrong and often makes nursing homes seem cleaner and safer than they are. The rating system also obscures how many residents are receiving powerful antipsychotic drugs.

But the problems with the inspection process, which are the core of the ratings system, are the most consequential. On-the-ground inspections are the most important factor in determining how many stars homes receive in Medicare’s rating system. The reports that inspectors produce give the public an unvarnished view inside facilities that house many of the country’s most vulnerable citizens.

On the rare occasions when inspectors issue severe citations, nursing homes can fight them through an appeals process that operates almost entirely in secret. If nursing homes don’t get the desired outcome via the informal review, they can appeal to a special federal court inside the executive branch. That process, too, is hidden from the public.

Even when the citations are upheld by this federal court, some never make their way onto the Medicare website, known as Care Compare. In November, for example, the court sustained a major punishment against Life Care Center of Kirkland, Wash. — the nursing home that faced the first coronavirus outbreak in the United States — yet the citation is absent from the Medicare site. The facility has a five-star rating.

The pattern gives nursing homes a powerful incentive to pursue every available appeal. Even if they lose, the process eats up time and reduces the odds of damaging information ever becoming public.

“There is every advantage to the facility not to have an opinion issued for as long as they could possibly delay, and there’s no advantage to the public for that to occur,” said Richard Routman, a lawyer who represented the federal government in nursing home appeals until 2014.

“Once I realized that people wouldn’t see cases that are on appeal, I thought, why would anybody ever look at this again?”

Representatives of the nursing home industry say it is only fair that they be allowed to appeal citations before they are made public, especially since many end up getting overturned or downgraded. But The Times found that the appeals process can be one-sided, excluding patients and their families.

Jonathan Blum, the chief operating officer for C.M.S., said that citations are omitted during state-level appeals to be fair to nursing homes that are disputing inspectors’ findings. He acknowledged that even after appeals are exhausted, some citations still don’t appear on Care Compare. He said C.M.S. is “working to correct this issue.”

‘Kinder and Gentler’

The biggest component of nursing homes’ star ratings are the inspections conducted by state health investigators. Facilities that ace their inspections are on track to get up to five stars, whereas those that flunk will struggle to get more than one or two stars.

There’s big money at stake. Because of the weight that people place on the star ratings, researchers have found a connection between better inspection results and greater profits. The Times analyzed nursing homes’ financial statements from 2019 and found that four- and five-star facilities were much more profitable than lower-rated facilities. (For-profit companies own about 70 percent of all U.S. nursing homes.)

Inspectors visit every nursing home once a year or so for general inspections and in response to complaints. They spend several days combing through medical records, tagging along with nurses and aides as they do their work, interviewing staff and residents and even testing the temperature of the morning coffee.

When inspectors encounter problems, they can propose issuing a citation. First, though, they must build a case by compiling things like witness statements and medical records. Supervisors often vet citations before they’re issued to ensure that violations are properly investigated and documented.

The vast majority of citations are minor. But a fraction are deemed serious, faulting nursing homes for putting their residents in “immediate jeopardy” or causing “actual harm.” On each nursing home’s listing on Care Compare, there is a section that shows whether they have received any such citation in recent years.

The violations then are incorporated into a formula that helps determine a facility’s star rating. The more severe the violations, the heavier the toll on the rating.

For decades, federal watchdog agencies have criticized state inspectors for taking a light touch with the nursing homes they oversee.

Inspectors rarely deem problems to be serious enough to harm homes’ star ratings. From 2017 to 2019, The Times found, inspectors wrote up more than 2,000 five-star facilities at least once for not following basic infection-control precautions, like having employees regularly wash their hands.

At 40 other five-star homes, inspectors determined that sexual abuse did not constitute actual harm or put residents in immediate jeopardy.

The reasons are complicated. Inspectors tend to be overworked and poorly paid. Writing up a facility for a serious violation requires extra paperwork and additional visits to check that the home has fixed the problem.

Another factor, inspectors say, is that they have been conditioned to expect blowback when they cite homes for serious problems.

“I feel sometimes the things I cite don’t mean anything because it gets tossed out at the state level or they determine it not to be as severe,” an unnamed inspector said in a 2013 survey conducted by the Center for Medicare Advocacy, a consumer rights group. “Sometimes it makes you wonder why we spin our wheels on a problem.”

Public officials have urged inspectors to nudge nursing homes to improve, instead of punishing them.

Oklahoma’s inspections agency referred to nursing homes as its “clients,” according to a letter from the agency reviewed by The Times. Inspectors in Pennsylvania complained about being told to be “kinder and gentler” with nursing homes, according to the 2013 survey. Last year, in the depths of the pandemic, the California department of health told inspectors to act as safety “consultants” to nursing homes and to not take on an enforcement role. (The policy was scrapped after inspectors objected.)

In Arkansas, some inspectors said supervisors discouraged them from citing homes for immediate jeopardy or actual harm, even when they spotted dangerous conditions.

“Deficiencies are thrown out all the time,” said Lisa Thomas, who previously oversaw the training of the state’s inspectors. (She said she was fired in 2019 after complaining to the governor’s office about the agency.)

Gavin Lesnick, a spokesman for the Arkansas Department of Human Services, denied that inspectors were discouraged from citing nursing homes for serious violations. He also denied that Ms. Thomas was fired for her complaint. “The safety and health of the patients is our number-one priority, and why all of our staff come to work every day,” he said.

Keeping Data Secret

When the state issues a citation against a nursing home, federal rules give the facility the right to appeal through what’s known as an informal dispute resolution process. The home can argue that inspectors were mistaken in their findings or that their proposed punishment was overly harsh.

Such reviews are supposed to take 60 days, but they sometimes drag on for more than a year, The Times found. Mr. Blum, the C.M.S. official, said facilities were required to fix any problems regardless of whether they appealed.

Procedures vary among states. Sometimes, the agency that issued the initial violation reviews its own work. Other times, states ask a nonprofit organization to make the decision. In Massachusetts, the process is left to a panel where a majority of members either represent or have worked for nursing homes. In Indiana, nursing home residents and their family are not permitted to attend hearings.

If a nursing home prevails, the citation is made less severe or deleted from the record altogether.

While the review is underway, the inspectors’ findings are not posted on the Care Compare website.

That’s why there is no public accounting of what happened at Sauer Health Care, a nursing home with five stars in eastern Minnesota, in April 2020.

State inspectors found that as Covid was spreading through the home — five residents would die in less than a month — the staff was not exercising basic precautions. Employees weren’t removing protective gear after they left a sick person’s room. The home wasn’t consistently screening staff for Covid symptoms. In one case, inspectors found that the home moved a resident who was coughing and had an elevated temperature into the room of a woman who had no symptoms. Both eventually tested positive for the virus.

Inspectors concluded that Sauer had placed its residents in immediate jeopardy. They ordered the home to develop an emergency plan to fix the problems, according to their 21-page report, which The Times obtained through an open-records request.

The nursing home appealed the ruling through the informal dispute resolution process and is still awaiting a decision, said Sara Blair, the administrator of Sauer Health. She wouldn’t explain the basis for the home’s appeal.

While decisions in these cases aren’t made public, homes like Sauer stand a good chance of winning.

The Times asked public health agencies in all 50 states how often citations were upheld, reduced in severity or deleted entirely since 2016. Eighteen states provided figures. About 37 percent of the time, the nursing homes succeeded in getting citations removed or reduced in severity.

The success rate varied from state to state. In Massachusetts, 36 percent of the citations that nursing homes appealed ended up being deleted. In Connecticut, facilities were successful at either erasing or reducing the severity of citations nearly half the time.

Multiple states declined to provide the data to The Times; two, Missouri and Florida, said they had been told not to by C.M.S. The federal agency declined to disclose nationwide figures to The Times.

Nursing homes say that the relatively high rate of successful appeals is a sign of problems with the inspection process.

“If I was the chief executive of a company and looking at an error rate of 40 percent, I’d think what is going wrong,” said Margaret Chamberlain, a lawyer who represents nursing homes.

But the appeals process tilts in favor of nursing homes because the facilities are the only ones to make their case; residents and their families are shut out of the process.

Regardless of the reason, visitors to the Care Compare website have no way of knowing if they are getting an incomplete picture of problems at a nursing home.

Heroin in a Purse

If a nursing home loses in the informal process, it can appeal to administrative law judges working for the Department of Health and Human Services. During that process, the citations are supposed to — but often don’t — appear on the Care Compare website.

These cases play out in courtrooms. But unlike most legal cases, there are no public dockets, where members of the public can look up the status of cases, the next court date or the latest legal filings. (A spokeswoman for the Department of Health and Human Services said the docket was private because filings in these cases often contain “sensitive information protected from public disclosure.”)

In April 2020, a team of state inspectors arrived at Brooke Knoll Village, a nursing home in Avon, Ind. They found the home had failed to isolate residents who were suspected of having Covid-19. The state concluded that Brooke Knoll had placed residents in immediate jeopardy, according to inspection documents reviewed by The Times.

Brooke Knoll, which didn’t respond to requests for comment, lost its initial appeal through Indiana’s informal dispute process, and it is appealing the violation to the federal government. A finding of immediate jeopardy often lowers a nursing home’s star rating, but Brooke Knoll still has five stars, and the citation does not appear on Care Compare.

Instead, the site says, “no health deficiencies found.”

“How do they get away with that?” said Tammy Bowman, whose sister was a resident at Brooke Knoll and contracted Covid just before the inspectors arrived at the home. She later died from the disease.

“I feel like you can’t hide something like that when we’re talking about somebody’s life,” Ms. Bowman said.

The appeals often shed light on serious violations that never made it onto Care Compare. The Times reviewed 76 federal administrative decisions published in 2020 and 2021. Ten violations that were upheld by the court were not posted to the federal website and didn’t affect the homes’ star ratings.

People checking Care Compare never found out that a resident was arrested at the Voorhees Care and Rehabilitation Center in New Jersey after being spotted placing heroin in another resident’s purse, and that a third resident died of an overdose.

The public never found out that inspectors cited another New Jersey nursing home, Rehab at River’s Edge, for failing to protect a fragile resident who fell seven separate times, at one point fracturing her foot.

And the public never found out that a resident at the Golden Living Center nursing home in Morgantown, W.Va., crashed to the ground and died after staff mistakenly removed the safety rails from his bed.

In all three of those cases, the state inspectors’ findings were upheld by a federal judge.

Mr. Blum, the C.M.S. official, didn’t say why such citations had never appeared on Care Compare. He said the agency was working to fix the problem. (The three homes declined to comment or didn’t respond to requests for comment. Golden Living is under new management.)

Dr. David Gifford, the chief medical officer of the American Health Care Association, which represents the nursing home industry, said the group’s members believed the appeals process should be faster and more transparent. He said Medicare should not post the results of inspections that are in dispute.

Found on the Pavement

On paper, Hilltop Rehabilitation, a sprawling ranch-style nursing home in Weatherford, Texas, seems like a place where little ever goes wrong. On Medicare’s rating website, the facility has won the highest scores on its health inspections for four years straight, not incurring a single serious infraction.

What’s missing from that picture, though, is what happened to Alan Hart’s mother, Laverne.

In 2014, he placed the 87-year-old retired children’s book author, who had dementia, at Hilltop because he was having trouble caring for her on his own.

Mr. Hart said it broke his heart to move her, but he thought she would be in good hands at the five-star nursing home, which planned to keep her on a supervised, locked floor.

In August 2015, Ms. Hart was left alone and tumbled from her wheelchair, injuring her shoulder, according to court documents and her son.

Then, shortly before Christmas, Ms. Hart was alone again. She wheeled herself out of unlocked doors to the facility’s parking lot, where she fell, smashing her face on the pavement. It was just above freezing outside, and she was wearing only a thin nightgown. More than 30 minutes had passed before she was found on the ground, her hair matted with blood and her nose broken.

Mr. Hart, a police officer, was at work when he got the call. As he sped to Hilltop, he prepared for the worst. “I thought she was dead for sure,” he said. “They didn’t supervise her at all.”

Inspectors agreed. They hit the facility with an immediate jeopardy citation for not properly supervising Ms. Hart, even though the home knew she was prone to wandering. The inspectors also faulted Hilltop for allowing her to fall on several occasions and for unnecessarily drugging her.

Hilltop, which didn’t respond to requests for comment, appealed the inspectors’ citation through the informal review process. The home lost. Then Hilltop appealed to the federal government. Four years later, in June 2020, an administrative law judge upheld the inspectors’ original findings.

C.M.S. never posted the citation off the Care Compare website. Hilltop has a nearly spotless inspection record.

Assault at the Dinner Table

Every year, C.M.S. sends special teams to about 5 percent of nursing homes to double-check state inspectors’ work. The idea is to enforce consistency and ensure that individual states are holding homes accountable to federal standards of nursing care.

Studies have found that federal inspectors tend to find more serious problems than their state counterparts during these examinations. But the Medicare agency does not publish the reports of its own inspectors — even when they turn up dangerous or deadly conditions — or factor them into homes’ star ratings.

The Times reviewed details of three federal inspection reports.

One involved the Lakeview Manor nursing home in Indianapolis. In March 2020, federal workers were following up on a state inspection from two months earlier when they found that Lakeview had placed a resident in danger by installing the wrong rails on her bed, increasing the risk that she would get entangled in them.

The same month, at Landerbrook Transitional Care in Mayfield Heights, Ohio, federal investigators discovered a woman smoking a cigarette while connected to a flammable oxygen tank.

The federal inspectors determined that both situations risked causing severe injury or death. Neither was disclosed to the public. (Representatives of Lakeview and Landerbrook didn’t respond to requests for comment.)

Mr. Blum of C.M.S. said federal surveys were excluded from the ratings system because they were designed to “assess a state survey agency’s performance,” not the quality of nursing homes.

Sun Health La Loma Care Center in Litchfield, Ariz., has a five-star rating . In January 2018, a 76-year-old woman went there to recover from surgery for a fractured femur. On her second evening there, a male resident beckoned her to his dinner table. Moments after she sat down, he pinched her breast. Terrified, the woman refused to eat in the dining room for the remainder of her stay.

When state inspectors visited Sun Health in June 2018, they said they could not substantiate the assault. Later that summer, though, federal inspectors came to a different conclusion.

They found that the male resident had a history of assaulting staff. The week before the incident in the dining room, he had groped his occupational therapist on three separate occasions. The nursing home had added a note to the man’s record warning staff to keep him away from female residents.

The federal inspectors cited the nursing home for causing actual harm to residents by failing to follow its own guidance and for allowing the assault to take place.

Ken Reinstein, a spokesman for Sun Health, said the nursing home disagrees with the federal finding and “cares very deeply about its residents and the care they receive.”

The only thing that visitors to Sun Health’s entry on Care Compare see are the minor issues identified by state inspectors. There is no trace of the serious problems uncovered by their federal counterparts.

Mark Walker , Kim Barker and Bret Schulte contributed reporting. Susan Beachy contributed research.

Robert Gebeloff is a reporter specializing in data analysis. He works on in-depth stories where numbers help augment traditional reporting. More about Robert Gebeloff

Katie Thomas is an investigative reporter who has been writing about the business of health care since 2012. More about Katie Thomas

Jessica Silver-Greenberg is an investigative reporter on the Business desk. She was previously a finance reporter at the Wall Street Journal. More about Jessica Silver-Greenberg

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Caught on hidden cameras - yet just 1% of care home abuse ends in charges

• Monday 3 July 2023 at 3:43pm

Lewis Denison

Westminster Producer

How many more vulnerable people are suffering in care homes? Geraint Vincent reports

Ann King’s children were horrified when they reviewed footage from the hidden camera they had installed in their mum's bedroom - and immediately rang the police.

It clearly showed the dementia patient, 88, had been subjected to a distressing catalogue of abuse at the care home in Surrey they were paying £8,000 a month to look after her.

Staff at Reigate Grange had mocked, teased, and manhandled Ann. They’d made lewd gestures, flickered light switches to confuse her, and left her struggling on the floor for nearly an hour.

But despite all this evidence captured on camera, Ann's abusers were never charged with a crime. The case was among over 1,000 allegations of abuse or neglect at care homes last year which did not result in criminal charges.

Freedom of information (FOI) requests by ITV News to police forces in England and Wales have revealed a charge rate of just 1.4% for allegations of this kind.

The 16 forces which responded told us they had received 1,080 allegations in 2022 - but just 16 charges were made.

And the problem is likely to be much more widespread, given the majority of the 43 forces in England and Wales said they were unable to respond to our request for information.

Care Campaign for the Vulnerable, a charity which supports victims and their families, told ITV News the figure provided by police is just the "tip of a very large iceberg".

Charity boss Jayne Connery, who is campaigning to have CCTV in care homes as a deterrent, said she is "not in the least bit surprised at the incredibly low levels of criminal charges pursued against abusers".

Clinical negligence lawyer Stephanie Prior, who works for Osbornes Law, told ITV News about the difficulties for families seeking justice - even with camera footage.

"Often to abuse an elderly person it can be quite subtle, desont have to be something thats visible or clear," she said, "especially if the resident has dementia and they’re not often aware of whats going on".

Ann's children Richard Last and Clare Miller only discovered the abuse their mum had been suffering after installing a secret camera in her bedroom.

The pair, who felt a lifetime of gratitude to the woman who adopted them, put their mum in a care home so she could be looked after professionally once her dementia had worsened.

"In fact, it turned out to be the complete opposite," Richard told ITV News.

He was concerned about his mum's treatment after she begged him to take her home with him during one visit to Reigate Grange.

"Mum was coming out with disturbing things like 'don’t leave me on my own, please don’t leave me, take me with you, can I come home with you'," he said.

"Sometimes she couldn't recall but then she would say people come in and hurt me."

And when his sister Clare, who has worked in the care sector for more than two decades, saw the footage for herself, she was astounded.

The mother and former nurse had spent her life caring for others, but when it was her turn to be looked after she was psychologically and physically tormented by those who were supposed to support her.

"I totally broke, because obviously it's full sound, it's full picture and it broke me," Clare said. She immediately called the police.

Surrey Police say they investigated the allegations after receiving Richard's footage but were told by the Crown Prosecution Service that the "thresholds for criminal charges of assault, abuse or neglect were not met."

It said one man - the most prolific of her abusers - was issued with a "community resolution order, which is an out of court disposal, but which would be taken into account should any further offences come to light".

Signature, the care group which runs Reigate Grange, told ITV News it wanted to apologise to her family once again for the abuse she suffered in early 2022.

"This was an isolated incident where the behaviour of the individuals concerned was reprehensible and fell far short of the standards of care we provide to our residents every day.

"We would like to again apologise to the King family for their experience.

“When the footage was first shared with us in May 2022, we immediately alerted the police, removed the individuals from the home, and took comprehensive action to ensure all other residents were safe."

It added it worked closely with police investigators at the time and all those implicated in the secret filming are no longer employed by Signature.

Claire Rintoul, who runs care group Sheffcare in Sheffield, told ITV News many homes struggle to employ caring staff because of a lack of respect for the profession.

"Unfortunately we’re just not as well regarded by the NHS, the staff aren’t paid as well. It's a really hard job.

"I think if it was given the status and the funded it needed, it would attract people who saw it as a proper career who saw the value in it.

"People really respect nurses and doctors. I don't think they respect social care workers in the same way."

The CPS says it would "prosecute every case referred to us that meets our legal test" and insisted it is "committed to seeing more cases going to court through closer working with the police".

It pointed out "not all reported incidents will be passed on to us by the police for a charging decision" and claimed it was misleading to say the CPS presided over a low crime charge rate in England and Wales.

Labour said the number of allegations of abuse and neglect in care homes is "totally unacceptable", with Shadow Social Care Minister Liz Kendall saying "there must be zero tolerance of this behaviour throughout the system. No ifs, no buts".

She added: "The government must now spell out why so few charges have been brought and the urgent steps that will be taken to guarantee everyone is safe in the place they call home."

The Department for Health and Social care declined to comment, as did the Home Office.

But Clare, who recently returned to work in the care sector after suffering a breakdown following her mum's treatment, told ITV News she wants ministers to work on specific care legislation she'd call Ann's Law.

She is calling for a register of care to be created, so anyone accused of inappropriate behaviour can be struck off, and for police to receive proper guidance to help them realise where abuse is taking place so it can be dealt with swiftly.

The National Police Chiefs' Council (NPCC), which represents forces in England and Wales, insisted any report of abuse is taken "incredibly seriously".

NPCC lead for adults at risk, Chief Superintendent Jim Gale, told ITV News forces work closely with agencies including the Care Quality Commission and local authorities to "consider issues raised by safeguarding leads and identify best practice".

He said police are "considering how this can be improved" and "looking at innovative ways" to protect adults at risk at an earlier stage before criminal offences are committed.

Mr Gale added: "A criminal charge is not the only potential outcome of an investigation, with out of court disposals or the use of barred lists also used where appropriate.

"Officers take into consideration all circumstances of a case, with victims' wishes at the centre of our decision-making.

"We will continue to work closely with our partners to improve our joint response to this area of vulnerability."

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November 9, 2022

Supreme Court to Hear Nursing Home Case That Could Affect Millions

The country’s highest court will decide whether Americans who rely on public assistance can sue states when they believe their rights have been violated

By Farah Yousry , Side Effects Public Media & KFF Health News

Owen Franken/Getty Images

When Susie Talevski sued the agency that managed her elderly father’s care before he died, she hoped to get justice for her family. She did not expect the case would grow into a national bellwether. A ruling against her could strip millions of vulnerable Americans of their power to hold states accountable when they do not receive benefits allowed by law.

“This case has taken on, really, a life of its own way beyond what I could have foreseen,” said Talevski, a resident of Valparaiso, Indiana.

Talevski filed a lawsuit in 2019 alleging that her father’s rights were violated at a nursing home where he lived to get care for his dementia.

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“He went from being able to walk and talk … to not being able to move,” Talevski said. “[The nursing facility] treated my dad like trash, like a dog. In fact, dogs are treated better than that.”

In court filings, the Talevski family claims that Gorgi Talevski was overmedicated to keep him asleep, his dementia wasn’t properly managed, and he was involuntarily transferred to different facilities hours away from the family’s home, which accelerated his decline. Her father died a year ago, in October.

Talevski sued  the Health and Hospital Corp. of Marion County, the public health agency in Indiana that owns the nursing facility. The agency, known as HHC, declined to comment on the case but has denied any wrongdoing. In court documents, it argued that Gorgi Talevski was  violent and sexually aggressive , which affected his care. It tried to dismiss the case, saying Talevski didn’t have the right to sue. But federal courts said the lawsuit could move forward.

So, the public health agency made an unexpected move. It took the case to the nation’s highest court and posed a sweeping question: Should people who depend on initiatives funded in part by the federal government — such as Medicaid and programs that provide services for nutrition, housing, and disabilities — be allowed to sue states when they believe their rights have been violated?

A ruling in favor of the HHC  could mean millions  of Americans who rely on federal assistance programs would lose that right. The Supreme Court is scheduled to hear oral arguments on Nov. 8.

“The reach of an adverse decision would be catastrophic,” said  Jane Perkins , an attorney at the National Health Law Program. “It would leave these programs really standing out there without a true enforcement mechanism.”

HHC of Marion County owns and operates 78 skilled nursing facilities across Indiana in a  public-private partnership  with  American Senior Communities .

The answer to the question of whether people who depend on federal assistance programs can sue over rights violations has been settled precedent for decades, said Perkins, who has litigated numerous civil rights cases for Medicaid beneficiaries.

For that reason, she was shocked when she learned the Supreme Court had chosen to hear this case. The Supreme Court  is asked to review nearly 7,000 cases  each year and they often agree to look at only 1%-2% of them.

Perkins said she sees parallels between this case and the recent Supreme Court decision that overturned the constitutional right to an abortion.

“The idea that the court would accept this case and accept that question of whether you can ever enforce these laws is of concern,” Perkins said. “The recent court decisions —  Dobbs  in the abortion context coming to mind — shows the court is willing to set aside precedent.”

Since the Supreme Court agreed to look at the case, at least  25 entities have filed amicus briefs , which provide courts information from people not directly involved in a case. Most have sided with the Talevskis — including  members of Congress  like House Speaker Nancy Pelosi and Majority Whip James Clyburn,  AARP ,  American Cancer Network ,  American Public Health Association , and  Children’s Health Care Providers and Advocates . Marion County HHC will be represented by  Lawrence Robbins , who has argued 19 cases before the Supreme Court and represented Christine Blasey Ford during the confirmation hearing of Justice Brett Kavanagh. Talevski will be represented by  Andrew Tutt  of Arnold & Porter. Recently, Tutt argued and won a case before the Supreme Court that safeguarded the reemployment rights of thousands of veterans and service members.

Programs that rely on federal money  flowing from Congress to states, like Medicaid, typically come with a set of provisions or requirements that states are supposed to follow to receive and use the funds. Civil rights lawsuits are one of the primary enforcement mechanisms beneficiaries of those programs have to hold state agencies accountable if the agencies violate their rights or fail to provide entitled services.

There are other means of oversight, which supporters of the Indiana state agency’s petition tout as viable alternatives to lawsuits. One is federal monitoring by the Department of Health and Human Services. The agency can investigate and threaten to withhold funding from state programs that fail to comply with federal provisions. But this usually involves lengthy legal processes that can be counterproductive, stalling benefits to individual patients, instead of helping them.

“If [HHS] tries to turn off the money, the state could take them to court immediately and get an injunction,” arguing that the ceasing of federal funds would cause irreparable harm, said  Sara Rosenbaum , a professor of health law and policy at George Washington University. “People [would be] left totally without their benefits, or the providers are left totally without their payments.”

Former senior HHS officials  say that federal oversight is far from sufficient and that civil rights lawsuits remain a crucial enforcement mechanism. Private enforcement through lawsuits is indispensable for nursing home residents, they say, especially in places like Indiana where the state owns the most nursing homes.

The former officials said in a  court brief  that a decision in favor of HHC would potentially raise the risk of waste, fraud, and abuse of Medicaid funds, leading to widespread underenforcement and leaving “millions of individuals, providers, and other beneficiaries more vulnerable to violations of their statutory rights.”

Nearly 83 million Americans , a quarter of the U.S. population, are enrolled in Medicaid. This means HHS oversees more than half a trillion dollars in spending across all states and U.S. territories — and the federal agency, the former officials argue, lacks the logistical and practical capacity to “meaningfully remedy individual violations in many cases.”

Indiana’s Attorney General, Todd Rokita, is among allies publicly supporting the state’s perspective. Rokita, in a  court brief  filed along with 21 other Republican attorneys general, said civil rights lawsuits burden states and cripple them with legal expenses, just to line the pockets of attorneys rather than benefit Medicaid enrollees.

“The state has litigated 1,200 civil rights cases just in the last three years,” Rokita said in a written statement.

Legal experts told Side Effects that the number Rokita cites is highly misleading because it lumps together all civil rights lawsuits, not just those that have to do with federal entitlement programs, which are at the heart of this case.

If the Supreme Court rules in favor of HHC, lawsuits like a 2015 case that won  Medicaid recipients the right  to an expensive hepatitis C drug may not be possible in the future, said  Emily Munson , an attorney with the advocacy group  Indiana Disability Rights .

When states tried to cap the benefits of people with disabilities in Indiana and across the nation,  civil rights lawsuits  have helped patients gain access to things like in-home support with day-to-day tasks, known as attendant care.

Munson has litigated similar cases. She has a disability herself, and the prospect of a Supreme Court decision in favor of Marion County terrifies her.

“I rely on Medicaid for attendant care, for wheelchair repairs,” Munson said, “and losing the ability to go to federal court if need be is very scary.”

During the  latest HHC board of trustees meeting in mid-October , the monumental case was absent from the agenda. But when the meeting opened for public comment, state representatives, patients, and advocates seized the opportunity to voice their concerns.

They had one demand for the agency: withdraw its Supreme Court petition.

State Rep. Robin Shackleford, an Indianapolis Democrat, and others in the legislature have been vocal about their concerns. Shackleford said many of her constituents are on Medicaid and  SNAP , the Department of Agriculture’s supplemental nutrition program.

“They would be horrified … if they knew the board was the driver behind removing their rights,” Shackleford said.

This story is part of a partnership that includes  Side Effects Public Media  — a public health news initiative based at WFYI,  NPR  and KHN.

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Britain's cruellest care home: 'Institutional abuse' contributed to deaths of five pensioners

Coroner criticises care quality commission for giving orchid view a 'good' rating in 2010, article bookmarked.

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Neglect stemming from "institutionalised abuse" at a care home directly contributed to the deaths of five of its elderly residents after ample warning signs were ignored or missed by managers and watchdogs, a coroner has ruled.

In a devastating verdict delivered hours after Health Secretary Jeremy Hunt conceded that "something is badly wrong" with the care system, West Sussex coroner Penelope Schofield there had been mismanagement "from the top down" at the Orchid View home run by the defunct provider Southern Cross.

Relatives said the findings meant the Crown Prosecution Service should review a decision not to bring charges against five people who were arrested - some on suspicion of manslaughter by gross negligence - following the death of one resident, 77-year-old Jean Halfpenny, who received an overdose of the blood-thinning drug Warfarin. Prosecutors had previously ruled there was insufficient evidence to proceed against any staff member.

But after a five-week inquest which heard multiple accounts of maltreatment of often immobile elderly people, Ms Schofield said she was satisfied that Mrs Halfpenny had been overdosed and then her medical records destroyed after it became clear she required hospital treatment. Meera Read, a manager of the home in Copthorne, near Crawley, denied she had looked at the documents for Mrs Halfpenny and falsified new ones after saying: "Shit, we can't send her to hospital with those. They will shut us down."

Describing the £3,000-a-month home as "an accident waiting to happen" before it was shut late in 2011, the coroner said: "There was institutionalised abuse throughout the home and it started, in my view, at a very early stage, and nobody did anything about it.

"This, to me, was from the top down. It was completely mismanaged and understaffed and failed to provide a safe environment for residents."

The case will renew scrutiny of the corporate culture of Southern Cross, which was Britain's largest care provider until its £1bn collapse in 2011 after a disastrous expansion strategy left it unable to pay the rent on many of the 700 homes it ran and left its 31,000 residents facing an uncertain future. The whistleblower who raised the alarm about Orchid View said she was ordered by managers to "fill the home, fill the home".

Linzi Collings, the daughter of Mrs Halfpenny, a retired dental receptionist who was at one point found naked and crying in bed by a social worker, said: "How the corporate failings of Southern Cross could create these events and how such terrible standards could go unnoticed by the authorities for so long has left us baffled.

"Our mum deserved to be treated with dignity and compassion but Orchid View failed to provide her with even a basic level of care."

She added: "If this inquest hasn't been the wake-up call the industry desperately needs, I dread to think how bad things could get."

The findings came after Mr Hunt called for Britons to take a closer interest in the welfare of elderly parents and grandparents, describing it as a "national shame" that as many as 800,000 people in England are categorised as chronically lonely. He said he was "particularly worried" about the 400,000 people in care homes.

Labour accused the Government of seeking to place the blame for problems with the care system solely on families rather than its spending cuts.

Witnesses at the inquest recounted how Orchid View was run "on a budget" with residents left soiled and unattended while others were locked in their rooms. In one case, a woman's fractured ankle went undiagnosed for several days while another had a dressing secured with Sellotape. A pharmacist who inspected the home was physically sick in the car park.

The coroner said that her inquiry into the death of 19 residents at the "state-of-the-art" home run by now defunct provider Southern Cross showed that all had received "sub-optimal" care and criticised the industry watchdog - the Care Quality Commission - for giving it a "good" rating in 2010.

Ms Schofield said that while the 19 people had died from natural causes, in the cases of five the deaths had been "attributed to by neglect". They were Ms Halfpenny, 85-year-old Wilfred Gardner, Margaret Tucker, 77, Enid Trodden, 86, and 85-year-old John Holmes.

Relatives of the five called for a public inquiry into the scandal but will have to await the results of a multi-agency serious case review announced yesterday before any further investigations are undertaken.

Ian Christian, of Irwin Mitchell solicitors, which represented seven of the families at the inquest, described the case as a "scandal". He said: "These were vulnerable people who used their life savings, or had their families pay money, so they would be cared for in the final stage of their life.

"They ought to have been in safe hands and provided with a standard of care which gave them dignity in their final days. Sadly this could not have been further from the truth."

The coroner said that those involved with the care of the five should feel "ashamed" and questioned why many of those who had worked at Orchid View were still employed in the industry. She added it was disgraceful that the home, which opened in 2009, had been allowed to run for two years without its problems being spotted, in particular by the CQC. Its January 2010 inspection found that Orchid View was a "well-maintained home that is clean throughout".

Ms Schofield said: "I question how this could be the case and I question whether the inspection that did take place was fit for purpose."

She added: "It's a heart-breaking case. We all have parents who will probably need care in the latter part of their lives."

With English councils referring 112,000 cases of abuse in care homes last year, the CQC earlier this week announced a new inspection regime bolstered by volunteers with experience of the care system to produce a clear ranking system for all 25,000 homes from next April onwards.

Andrea Sutcliffe, the CQC's first ever chief inspector of adult social care, said she was "shocked" by the treatment received by those at Orchid View and promised a "root-and-branch review" of the body's actions in relation to the home.

The purpose-built home was described as having a "five-star fee" when it opened in September 2009 with relatives saying they felt "seduced" into believing that its modern facilities meant it would be well run.

One staff member said: "It was like a car that looked good from the outside but it was knackered."

The inquest heard that residents were treated with a lack of respect and dignity, with call bells going unanswered or out of reach for bed-bound pensioners.

One resident was found naked and in pain with his catheter twisted while staff were found eating toast and drinking tea with their feet up. When asked by a relative why the man was being left in pain, a worker is alleged to have replied: "Everyone is entitled to a break."

The inquest heard that police and social services were called in to the home only after a whistleblower - administrator Lisa Martin - reached breaking point when she was told there had been 28 errors in administering drugs in a single shift and new manager replied "do what you like".

Miss Martin, who also made the allegations that Miss Read had ordered the shredding of Mrs Halfpenny's medical administration record, said: "I felt I had no choice. I couldn't watch this happen any more. I thought it could be my mum in that situation. I was telling everyone what was going on, but no one would listen."

Top-down failings: Death in care

The victims:

Wilfred Gardner, 85. Died May 2011

Relatives of Mr Gardner, who was diabetic, say they never saw a care plan for him. He was sometimes not provided with strips to test his blood sugar and his family were told he needed to ask if he wanted medication. As a dementia sufferer, they said he had no way to ask.

Jean Halfpenny, 77. Died May 2010.

The inquest found that Mrs Halfpenny was given an overdose of three times the required amount of the blood-thinning drug Warfarin. The stroke victim was left unattended and found by a social worker naked and crying in her bed.

John Holmes, 85. Died September 2011

The dementia sufferer was found soaking wet in bed without incontinence pads. He was made to wear soiled pads during the day, when he did not need them. He lost a stone in weight during the seven weeks he stayed at Orchid View before his death.

Margaret Tucker, 77. Died July 2011

It was several days before Mrs Tucker, a dementia sufferer, was found by staff to have fractured her ankle. Her daughter told the inquest she believed information about how the injury happened was deliberately withheld from her. Mrs Tucker also suffered unexplained bruising and on one occasion was left hanging half out of her bed for two hours.

Enid Trodden, 86. Died October 2011

Mrs Trodden, who had dementia and Parkinson’s disease, suffered bruising attributed to inappropriate handling. On one occasion she was found in bed at 4.30pm, cold and wet and with the curtains drawn, with both breakfast and lunch left on a bedside table.

FOCUS: SOUTHERN CROSS

Jonathan Brown

Southern Cross, which at its peak operated more than 750 care homes, went bust in 2011. The collapse of the operator sent shockwaves through the sector and brought the threat of upheaval and trauma for the 30,000 residents in its care.

The one-time private equity-backed company slipped from its position as the UK's leading provider of care services with a stock market value of £1.1bn to being unable to pay its landlords as the price of its shares plunged by 98 per cent in three years.

Between 2004 and 2006 the company had gone on an aggressive spending spree buying up rival care homes and later selling them on before renting them back on fixed leases.

But the 2008 financial crisis, the collapse in property prices and ensuing austerity budgets meant local authorities sought to save money by raising the eligibility criteria for new residents.

Unable to maintain occupancy rates of more than 90 per cent which it needed to meet the punishing repayment schedules, the company was unable to pay its annual £250m rent bill and was forced to restructure before ultimately collapsing. The care homes reverted back to their landlords.

At the time of the closure its former owners, the American private equity group Blackstone, said it was not to blame despite claims it had made £1bn during the expansion phase. The controversial sale and leaseback deal had infuriated unions representing the provider's 44,000 employees. Blackstone sold its interest in the business in 2006.

During the long boom years private equity companies had eyed the care home market as highly lucrative based on the promise of the growing needs of the UK's rapidly ageing population. But in Southern Cross's case and a number of small operators that closed in its wake, it was a business opportunity that was to prove fatally flawed.

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• v.13(4); 2021 Apr

Elder Abuse: A Comprehensive Overview and Physician-Associated Challenges

Karan patel.

1 Medicine, Cooper Medical School, Camden, USA

Sean Bunachita

2 Molecular and Cellular Biology, Johns Hopkins University, Baltimore, USA

Hannah Chiu

Prakul suresh.

3 Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA

Urvish K Patel

4 Public Health and Neurology, Icahn School of Medicine at Mount Sinai, New York, USA

Elder abuse can present in many forms, including physical abuse, psychological/emotional abuse, sexual abuse, financial abuse, and neglect. Many studies estimate that about 10% of all people over the age of 65 experience some form of abuse. These rates are often higher in long-term care facilities such as nursing homes, despite government regulations aimed toward addressing this issue. Because patients who experience abuse tend to have higher rates of hospitalization and mortality, it is important for physicians to be able to accurately identify cases of abuse. However, many studies have found that healthcare professionals are often undertrained and ill-equipped in diagnosing elder abuse. In this article, we outline tools that may be able to aid healthcare professionals in their diagnoses, such as survey-based methodology and common physical signs of abuse. In addition, we propose evidence-based solutions, including the use of multidisciplinary teams and increased training on the subject, so that healthcare professionals can more easily identify victims of abuse. Essentially, it is our hope that this article further spotlights elder abuse and its challenges, while serving as a guide to healthcare professionals. 

Introduction and background

The World Health Organization (WHO) defines elder abuse as, “a single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person" [ 1 ]. Unfortunately, elder abuse is prevalent around the world, with studies finding that 10% of all people over the age of 65 experience some form of abuse, with rates still continuing to rise [ 2 , 3 ]. Despite these alarming numbers and trends, it is estimated that only 1 in 14 cases of elder abuse are reported to the correct authorities [ 4 ]. Elder abuse can result in serious psychological and physical consequences for victims. Studies have shown that victims of abuse are almost three times as likely to suffer hospitalizations than their counterparts; victims of abuse have also been shown to have significantly higher mortality rates [ 5 , 6 ]. Physicians and other health care providers are among the few that may have an opportunity to intervene when someone is being abused. While taking a history and conducting a physical exam, physicians may be able to detect signs of subtle underlying abuse that a victim may cover up in a normal setting. However, physicians are often under trained and unconfident in their ability to identify abuse in [ 7 ]. As a result, many preventable cases of elder abuse go unnoticed each year.

Forms of elder abuse

Elder abuse comes in various forms which include: (1) physical abuse, (2) psychological/emotional abuse, (3) sexual abuse, (4) financial abuse, and (5) neglect. Physical abuse is defined as any intentional act that results in harm to a person. Psychological or emotional abuse includes verbal threats, harassment, intimidation, and isolation. Sexual abuse occurs when a victim either is forced into a non-consensual act or is incapable of consenting to such an action. Examples of this include, but are not limited to, rape, forced nudity, and inappropriate touching [ 8 ]. Financial exploitation occurs when the abuser is controlling and misusing the victim’s financial accounts. The misuse can include actions such as changing a will, stealing from bank accounts, and performing financial transactions that are not in the best interest of the victim [ 9 , 10 ]. Finally, neglect pertains to situations in which a caretaker does not adequately fulfill their duties; this includes such actions as not taking an elder to their doctor’s appointments and not assisting them with daily activities they cannot do themselves, such as personal hygiene maintenance [ 8 ]. A study conducted by Acierno et al. found that the most common types of abuse experienced by their sample were financial abuse, neglect, emotional abuse, physical abuse, and sexual abuse, in that order [ 11 ]. Nonetheless, the prevalence of each type of abuse has yet to be fully determined, though some studies argue that neglect is actually the most common form of abuse [ 10 , 12 ]. The lack of a clear answer may be a result of variations in settings and methods between studies. As stated previously, elder abuse, in general, is associated with an increased risk of hospitalization and death. One study found an elevated risk of death in patients who experienced elder mistreatment compared to those who did not (odds ratio: 3.1, 95% confidence interval: 1.4-6.7) [ 6 ]. Another study by Dong et al. found an increased risk of hospitalization (odds ratio: 1.97, 95% confidence interval: 1.33-2.61) among victims of abuse [ 5 ]. One thing to note is that rates of hospitalization vary among the different subcategories of abuse. Psychological abuse and neglect were most associated with increased hospitalization, while financial abuse was ranked lower among abuse-related risk factors [ 5 ].

Abuse in long-term care facilities

Nursing homes and other long-term care facilities are among the places with the highest rates of elder abuse. Widespread concern over this first became apparent in the 1970s when there were almost no federal regulations for these facilities [ 13 ]. In 1986, the Institute of Medicine, at the request of Congress, conducted a study in which they found high rates of abuse and neglect among nursing home residents. In 1987, the Nursing Home Reform Act (NHRA), as part of the Omnibus Budget Reconciliation Act, was passed in order to help ensure the overall well-being of residents through federal regulations. The act included laws such as providing Medicare and Medicaid payments to nursing homes only if they complied with government requirements [ 14 ]. The main commandments set forth by the NHRA were tenfold: residents of nursing homes had “(1) the right to freedom from abuse, mistreatment, and neglect, (2) the right to freedom from physical restraints, (3) the right to privacy, (4) the right to accommodation of medical, physical, psychological, and social needs, (5) the right to participate in resident and family groups, (6) the right to be treated with dignity, (7) the right to exercise self-determination, (8) the right to communicate freely, (9) the right to participate in the review of one's care plan and to be fully informed in advance about any changes in care, treatment, or change of status in the facility, and (10) the right to voice grievances without discrimination or reprisal” [ 14 ].

Despite government efforts, elder abuse in nursing homes continues to remain a major problem [ 15 ]. The main types of abuse in nursing homes are as follows: physical abuse (29%), resident-to-resident abuse (22%), gross neglect (14%), financial abuse (7%), and sexual abuse (7%) [ 16 ]. A study conducted by Hawes et al. found that 40% of the staff in their sample reported committing at least one instance of psychological abuse over a 12-month period. These actions included, but were not limited to, yelling and swearing at residents, inappropriate isolation, and denying food privileges [ 17 ]. Another study found that 50% of the nursing home staff admitted to mistreating older patients, 17% of certified nursing assistants (CNAs) reported pushing, shoving, or grabbing a nursing home resident, 23% of CNAs reported swearing at residents, and 51% reported yelling at residents [ 16 ]. These numbers were significantly higher when residents were interviewed about their own experiences. In a study of over 2000 nursing home residents, 44% said they had been abused and 95% said that they had either themselves been neglected or seen another resident be neglected [ 16 ]. While the actions of abusers should never be justified, and we by no means condone them, they may be partially explained by the fact that nursing home staff and healthcare professionals are overworked and understaffed, which may contribute to their growing frustrations. They may then take these frustrations out on the residents in a stint of misplaced anger [ 18 ]. One study found that up to 90% of nursing homes are understaffed, and one nurse’s aide may have to take care of up to thirty patients at once. This is in spite of recommended guidelines for the nursing aide to resident ratio, which typically ranges from 1:3 to 1:6 [ 15 ]. As a result, nursing home reforms, including hiring more employees, may be a critical step to reduce rampant abuse.

Risk factors for elder abuse

In Table ​ Table1, 1 , we list factors that are commonly associated with perpetrators and victims of abuse. While this is by no means an exhaustive list, it may serve as a guide to aid in the diagnosis of elder abuse. One thing of note is that there are studies that have found conflicting results with some common risk factors. For example, while many studies cite co-inhabitance as a risk factor for abuse, a study conducted by Li et al. found that living alone was actually a risk factor for abuse [ 19 ]. Meanwhile, another study by Pérez-Cárceles et al. found that co-inhabitance was a risk factor only if the perpetrator had a mental health disorder [ 20 ]. We cite these studies here to remind readers that risk factors should only serve as a starting point and cannot solely be used to raise clinical suspicion for abuse. 

Diagnosing elder abuse

It is important for elder abuse to first be accurately detected and diagnosed so that swift action can then be taken to intervene before the patient faces any further mistreatment. Yet, studies have shown that healthcare professionals are often inadequately equipped to identify cases of abuse. A US national survey of Emergency Department physicians found that 74% were uncertain whether elder abuse had been clearly defined and characterized, while 58% of physicians lacked confidence in their ability to correctly identify abuse in elderly patients [ 25 ]. This is an especially vital consideration since symptoms of elder abuse often mimic those found in other medical conditions. For example, burns can be mimicked by contact dermatitis while a bone fracture can be a symptom of osteoporosis [ 26 ]. Thus, it is crucial that healthcare providers are able to accurately differentiate between abuse and other conditions so that the appropriate treatment plan can be established. Below are a number of resources and methods that have been typically used to aid with the diagnosis of elder abuse. 

Patient history

An essential first step to identifying elder abuse is to ascertain the patient’s history in order to uncover potential risk factors and signs of current abuse. During this time, the healthcare provider should take note of patterns indicating abuse, such as lack of attendance for follow-up appointments, high frequency of injuries, and failing to promptly treat illness or injury [ 9 ]. It is crucial to interview the patient in a private setting, without any relatives or caregivers present, as the abuser(s) may be among that group. Additionally, it is important that the patient is as honest as possible in their answers, and they may be hesitant to share details of abuse if others are in the room [ 13 ]. Physician trust can be further gained by being sympathetic and nonjudgmental of the patient’s answers [ 13 ]. A number of screening tools have also been developed to supplement the history-taking process. These are generally a series of standardized questions either asked to or completed by the patient and help guide the physician to the next course of action. Three examples of common screening tools are shown next. 

Screening tools

Elder abuse suspicion index: The Elder Abuse Suspicion Index (EASI) is a two-minute screening tool that features a questionnaire of six dichotomous yes/no survey items, with five answered by the patient and one answered by the physician. When administered to cognitively intact patients 65 years of age or older, the assessment was found to have a sensitivity of 47% and a specificity of 75% if at least one EASI item was answered “yes” [ 27 ]. The EASI instrument possesses a number of advantages: (1) it can be conducted in a short time span, (2) it has been validated for both the English and French languages, and (3) it has been validated in a primary care setting [ 27 , 28 ]. However, it also contains some limitations: it can only be used for cognitively intact elderly patients seen by primary care physicians and it does not offer an evaluation of patient caregivers [ 29 ]. 

Elder assessment instrument: The Elder Assessment Instrument (EAI) is a 44-item screening tool that includes evaluations of social habits, medical history, and emotional/psychological neglect in the patient, among other questions. Each question is scored on a Likert scale ranging from 1 (no evidence) to 4 (evidence) [ 30 ]. The questionnaire takes approximately 15 minutes to complete and has a sensitivity of 71% and a specificity of 93% when administered by emergency department nurses [ 28 , 29 ]. A few advantages of the EAI are that it is relatively simple to administer, it has been validated in both the English and Spanish languages, and it has been validated for administration by nurses [ 30 ]. Some drawbacks of the assessment are its lack of an overall scoring system and lack of validation in subcategories [ 31 ]. 

Older adult psychological abuse measure: A third screening tool is the Older Adult Psychological Abuse Measure (OAPAM). The OAPAM is self-administered and specifically assesses psychological abuse by examining the level of risk in factors including isolation, insensitivity and disrespect, shaming and blaming, and reported threats and intimidation, as well as a category for other trusted risk factors [ 29 ]. In subjects who had already experienced an instance of violence and were found to be cognitively intact (as assessed by the Mini-Mental State Examination, or MMSE), one study found that the OAPAM showed 92% reliability [ 29 , 31 ]. However, the study was limited in that it only included participants located in Chicago, Illinois, so additional validation studies will need to be conducted in other populations. 

Physical exam

Following suspected elder abuse, it is imperative to conduct a comprehensive physical examination by a trained healthcare professional to uncover further evidence. The exam should encompass the patient’s entire body with a specific focus on detecting signs of abuse. Some common physical signs of mistreatment include welts, bite marks, fractures, dehydration, sexually transmitted infections, and poor hygiene [ 32 ]. It is also important to observe interactions between the patient and caregiver, looking for signs of anxiety or poor eye contact in the patient [ 9 ]. If possible, any findings should be further investigated and confirmed through laboratory testing. Some indications of abuse that can be detected through lab screening are dehydration, malnutrition, low medication levels, and drug poisoning [ 9 ]. 

Elder abuse reporting and treatment

Nearly all states, with the exception of New York, have laws stipulating mandatory reporting by healthcare professionals even under merely the suspicion of elder abuse [ 13 ]. This typically entails notifying a government regulatory agency, such as the Adult Protective Services (APS), who would then assign a social worker to investigate claims of elder mistreatment. If the patient is deemed to be in a sufficient cognitive state to make their own decisions, then they are free to decline further aid if they desire [ 32 ]. Should social assistance continue, then subsequent interventions tend to involve the cooperation of many different support systems throughout the community over long time periods [ 13 ]. While physicians often play a critical role in initially detecting elder abuse, they lack the amount of free time required to fully sustain follow-up and treatment alone. Thus, successful care must involve the interplay and coordination of a multidisciplinary team of trained professionals [ 13 ]. 

The ultimate goal of treating elder abuse is to ensure that every facet of the patient’s well-being is promptly addressed and that further mistreatment is prevented. Physical injuries are the first priority to reduce bodily pain and increase the quality of life [ 9 ]. Thereafter, the team should manage other forms of abuse, such as psychological, social, or financial. This could involve a number of interventions, such as mental health services, home health care, and meal delivery [ 13 ]. In the end, it is up to the discretion of the interprofessional team to determine the optimal treatment plan for each patient’s unique situation. 

Despite the legal requirements and resources available for reporting elder abuse, it has still been found to be the least reported type of domestic violence [ 33 ]. Physicians and other healthcare professionals are hesitant to report elder abuse for a myriad of reasons. They may believe that patients would be moving from one unwanted environment to another: that of understaffed and unsatisfactory care facilities [ 34 ]. Another concern for physicians is being sued for malpractice, especially if the physician reports suspected abuse when it is not actually occurring [ 35 ]. Further, elder abuse may not be reported due to a lack of training on how to do so. For example, a survey of Emergency Medical Services (EMS) providers discovered that there was an absence of protocols specific to reporting concerns in vulnerable elderly populations [ 36 ]. Finally, if the abuse is perpetrated by a close relative, health professionals may view the issue as a family matter that they should not intrude upon [ 33 ].

Potential challenges and associated solutions

Elder abuse persists due to the lack of awareness and education made available to key professionals. In order to bridge the gaps in detection and reporting, it is necessary to increase the hours of training on this topic for medical professionals. The majority of physicians reported their training on elder abuse to be not very adequate or not adequate at all, with most reporting no more than 10 hours of training. Additionally, two-thirds of residency programs fail to prioritize formal elder abuse training, and half of the physicians surveyed report having no residency training in elder abuse detection at all [ 4 , 37 ]. Thus, the best strategy to combat the lack of awareness is to emphasize and increase the training that is done in medical residency programs, making the requirement for elder abuse training a part of the curriculum [ 38 ]. It has been demonstrated that physicians who were offered continuing medical education (CME) for elder abuse were less likely to ignore the abuse of their patients as a barrier to reporting [ 4 ]. 

Furthermore, as mentioned previously, nursing homes show high rates of abuse, with one study of elders in nursing facilities finding that 44% of respondents had been subjected to prior mistreatment [ 39 ]. As with physician training, a key step to preventing elder abuse is to increase the education of nursing home caretakers and staff-members. These onsite training sessions teach caretakers how to utilize assistive equipment and raise awareness through discussing what to expect as individuals age, their mental health, and the specific illnesses of individual residents. A handful of nursing homes also prioritize educating residents and their family members, planning lighthearted activities that remind elders of the rightful treatment they should expect to receive [ 40 ]. Beyond this, many nursing homes purposefully remind residents of their safety in an overt way. They help facilitate a relationship between elders and the local police department and make crime prevention and abuse hotlines readily available for staff and residents. Many also have security systems in place and take the initiative to secure the residents’ valuables [ 40 ]. Collectively, these practices contribute to creating a safer environment. 

Additionally, many elders experience little relief or justice after facing financial abuse. This is partly due to the reluctance or inability of the elder to testify - but even if a victim is willing to prosecute, they can experience significant obstacles along the way. These include a high standard of proof for evidence that abuse has occurred, a lack of professional knowledge, and communication difficulties if the patient is cognitive- or speech-impaired [ 41 ]. One strategy to streamline the process of prosecution is to utilize multi-disciplinary teams, which include professionals within the justice system, physicians, nurses, mental health workers, and protective services. Having this array of professionals allows access to resources like neuropsychological testing, medical records, and legal services, which increase the likelihood of the case being reviewed, charged, and successfully prosecuted [ 42 ].

While these solutions have been proven to be effective, there are some limitations to them. Increased training during residency can require multi-disciplinary collaboration and agreement within each individual institution, and redeveloping parts of the curriculum will require thorough planning and execution. This includes spending time to seek out experienced and trustworthy educators for training both physicians and care-teams at nursing homes on the ways that they can identify and handle elder abuse. Additionally, whether it is providing additional education or offering expansive resources to support specific cases of elder abuse, organizations must be prepared to allot the appropriate funds needed to support these types of initiatives. Nevertheless, these challenges can be overcome and should be prioritized for the sake of mitigating elder abuse.

Conclusions

Elder abuse is a complex, multifaceted problem that stems from many underlying issues. Despite government intervention, abuse continues to remain a rampant issue in society with studies showing approximately 10% of people over the age of 65 experiencing some form of abuse. Physicians and other healthcare professionals have a unique opportunity to be able to intervene in such cases but are ill-equipped to do so with the current training they receive. As a result, health care professionals should receive more formal training, either in medical school or during residency, in order to increase their confidence in detecting suspected cases of abuse. Additionally, there are more complex issues at hand, such as fear of violating physician-patient trust and widespread misinformation about reporting cases. While these are far more difficult to address, we must take the first steps in the right direction by educating our health care professionals. As awareness about this issue increases, these secondary barriers may begin to be addressed through increased knowledge and further investigation.

The content published in Cureus is the result of clinical experience and/or research by independent individuals or organizations. Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein. All content published within Cureus is intended only for educational, research and reference purposes. Additionally, articles published within Cureus should not be deemed a suitable substitute for the advice of a qualified health care professional. Do not disregard or avoid professional medical advice due to content published within Cureus.

The authors have declared that no competing interests exist.

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40 facts about elektrostal.

Written by Lanette Mayes

Modified & Updated: 02 Mar 2024

Reviewed by Jessica Corbett

Elektrostal is a vibrant city located in the Moscow Oblast region of Russia. With a rich history, stunning architecture, and a thriving community, Elektrostal is a city that has much to offer. Whether you are a history buff, nature enthusiast, or simply curious about different cultures, Elektrostal is sure to captivate you.

This article will provide you with 40 fascinating facts about Elektrostal, giving you a better understanding of why this city is worth exploring. From its origins as an industrial hub to its modern-day charm, we will delve into the various aspects that make Elektrostal a unique and must-visit destination.

So, join us as we uncover the hidden treasures of Elektrostal and discover what makes this city a true gem in the heart of Russia.

Key Takeaways:

• Elektrostal, known as the “Motor City of Russia,” is a vibrant and growing city with a rich industrial history, offering diverse cultural experiences and a strong commitment to environmental sustainability.
• With its convenient location near Moscow, Elektrostal provides a picturesque landscape, vibrant nightlife, and a range of recreational activities, making it an ideal destination for residents and visitors alike.

Known as the “Motor City of Russia.”

Elektrostal, a city located in the Moscow Oblast region of Russia, earned the nickname “Motor City” due to its significant involvement in the automotive industry.

Home to the Elektrostal Metallurgical Plant.

Elektrostal is renowned for its metallurgical plant, which has been producing high-quality steel and alloys since its establishment in 1916.

Boasts a rich industrial heritage.

Elektrostal has a long history of industrial development, contributing to the growth and progress of the region.

Founded in 1916.

The city of Elektrostal was founded in 1916 as a result of the construction of the Elektrostal Metallurgical Plant.

Located approximately 50 kilometers east of Moscow.

Elektrostal is situated in close proximity to the Russian capital, making it easily accessible for both residents and visitors.

Known for its vibrant cultural scene.

Elektrostal is home to several cultural institutions, including museums, theaters, and art galleries that showcase the city’s rich artistic heritage.

A popular destination for nature lovers.

Surrounded by picturesque landscapes and forests, Elektrostal offers ample opportunities for outdoor activities such as hiking, camping, and birdwatching.

Hosts the annual Elektrostal City Day celebrations.

Every year, Elektrostal organizes festive events and activities to celebrate its founding, bringing together residents and visitors in a spirit of unity and joy.

Has a population of approximately 160,000 people.

Elektrostal is home to a diverse and vibrant community of around 160,000 residents, contributing to its dynamic atmosphere.

Boasts excellent education facilities.

The city is known for its well-established educational institutions, providing quality education to students of all ages.

A center for scientific research and innovation.

Elektrostal serves as an important hub for scientific research, particularly in the fields of metallurgy, materials science, and engineering.

Surrounded by picturesque lakes.

The city is blessed with numerous beautiful lakes, offering scenic views and recreational opportunities for locals and visitors alike.

Well-connected transportation system.

Elektrostal benefits from an efficient transportation network, including highways, railways, and public transportation options, ensuring convenient travel within and beyond the city.

Famous for its traditional Russian cuisine.

Food enthusiasts can indulge in authentic Russian dishes at numerous restaurants and cafes scattered throughout Elektrostal.

Home to notable architectural landmarks.

Elektrostal boasts impressive architecture, including the Church of the Transfiguration of the Lord and the Elektrostal Palace of Culture.

Offers a wide range of recreational facilities.

Residents and visitors can enjoy various recreational activities, such as sports complexes, swimming pools, and fitness centers, enhancing the overall quality of life.

Provides a high standard of healthcare.

Elektrostal is equipped with modern medical facilities, ensuring residents have access to quality healthcare services.

Home to the Elektrostal History Museum.

The Elektrostal History Museum showcases the city’s fascinating past through exhibitions and displays.

A hub for sports enthusiasts.

Elektrostal is passionate about sports, with numerous stadiums, arenas, and sports clubs offering opportunities for athletes and spectators.

Celebrates diverse cultural festivals.

Throughout the year, Elektrostal hosts a variety of cultural festivals, celebrating different ethnicities, traditions, and art forms.

Electric power played a significant role in its early development.

Elektrostal owes its name and initial growth to the establishment of electric power stations and the utilization of electricity in the industrial sector.

Boasts a thriving economy.

The city’s strong industrial base, coupled with its strategic location near Moscow, has contributed to Elektrostal’s prosperous economic status.

Houses the Elektrostal Drama Theater.

The Elektrostal Drama Theater is a cultural centerpiece, attracting theater enthusiasts from far and wide.

Popular destination for winter sports.

Elektrostal’s proximity to ski resorts and winter sport facilities makes it a favorite destination for skiing, snowboarding, and other winter activities.

Promotes environmental sustainability.

Elektrostal prioritizes environmental protection and sustainability, implementing initiatives to reduce pollution and preserve natural resources.

Home to renowned educational institutions.

Elektrostal is known for its prestigious schools and universities, offering a wide range of academic programs to students.

Committed to cultural preservation.

The city values its cultural heritage and takes active steps to preserve and promote traditional customs, crafts, and arts.

Hosts an annual International Film Festival.

The Elektrostal International Film Festival attracts filmmakers and cinema enthusiasts from around the world, showcasing a diverse range of films.

Encourages entrepreneurship and innovation.

Elektrostal supports aspiring entrepreneurs and fosters a culture of innovation, providing opportunities for startups and business development.

Offers a range of housing options.

Elektrostal provides diverse housing options, including apartments, houses, and residential complexes, catering to different lifestyles and budgets.

Home to notable sports teams.

Elektrostal is proud of its sports legacy, with several successful sports teams competing at regional and national levels.

Boasts a vibrant nightlife scene.

Residents and visitors can enjoy a lively nightlife in Elektrostal, with numerous bars, clubs, and entertainment venues.

Promotes cultural exchange and international relations.

Elektrostal actively engages in international partnerships, cultural exchanges, and diplomatic collaborations to foster global connections.

Surrounded by beautiful nature reserves.

Nearby nature reserves, such as the Barybino Forest and Luchinskoye Lake, offer opportunities for nature enthusiasts to explore and appreciate the region’s biodiversity.

Commemorates historical events.

The city pays tribute to significant historical events through memorials, monuments, and exhibitions, ensuring the preservation of collective memory.

Promotes sports and youth development.

Elektrostal invests in sports infrastructure and programs to encourage youth participation, health, and physical fitness.

Hosts annual cultural and artistic festivals.

Throughout the year, Elektrostal celebrates its cultural diversity through festivals dedicated to music, dance, art, and theater.

Provides a picturesque landscape for photography enthusiasts.

The city’s scenic beauty, architectural landmarks, and natural surroundings make it a paradise for photographers.

Connects to Moscow via a direct train line.

The convenient train connection between Elektrostal and Moscow makes commuting between the two cities effortless.

A city with a bright future.

Elektrostal continues to grow and develop, aiming to become a model city in terms of infrastructure, sustainability, and quality of life for its residents.

In conclusion, Elektrostal is a fascinating city with a rich history and a vibrant present. From its origins as a center of steel production to its modern-day status as a hub for education and industry, Elektrostal has plenty to offer both residents and visitors. With its beautiful parks, cultural attractions, and proximity to Moscow, there is no shortage of things to see and do in this dynamic city. Whether you’re interested in exploring its historical landmarks, enjoying outdoor activities, or immersing yourself in the local culture, Elektrostal has something for everyone. So, next time you find yourself in the Moscow region, don’t miss the opportunity to discover the hidden gems of Elektrostal.

Q: What is the population of Elektrostal?

A: As of the latest data, the population of Elektrostal is approximately XXXX.

Q: How far is Elektrostal from Moscow?

A: Elektrostal is located approximately XX kilometers away from Moscow.

Q: Are there any famous landmarks in Elektrostal?

A: Yes, Elektrostal is home to several notable landmarks, including XXXX and XXXX.

Q: What industries are prominent in Elektrostal?

A: Elektrostal is known for its steel production industry and is also a center for engineering and manufacturing.

Q: Are there any universities or educational institutions in Elektrostal?

A: Yes, Elektrostal is home to XXXX University and several other educational institutions.

Q: What are some popular outdoor activities in Elektrostal?

A: Elektrostal offers several outdoor activities, such as hiking, cycling, and picnicking in its beautiful parks.

Q: Is Elektrostal well-connected in terms of transportation?

A: Yes, Elektrostal has good transportation links, including trains and buses, making it easily accessible from nearby cities.

Q: Are there any annual events or festivals in Elektrostal?

A: Yes, Elektrostal hosts various events and festivals throughout the year, including XXXX and XXXX.

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Simulation of the sulfide phase formation in a KhN60VT alloy

• Simulation of Metallurgical and Thermal Processes
• Published: 23 September 2017
• Volume 2017 , pages 447–453, ( 2017 )

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• I. V. Kabanov 1 ,
• E. V. Butskii 1 ,
• K. V. Grigorovich 2 &
• A. M. Arsenkin 2  

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The conditions of the existence of sulfide phases in Fe–Ni–S alloys and four-component Fe–50 wt % Ni–0.001 wt % S– R ( R is an alloying or impurity element from the TCFE7 database) systems are studied using the Thermo-Calc software package and the TCFE7 database. The modification of nickel superalloys by calcium or magnesium is shown to increase their ductility due to partial desulfurization, the suppression of the formation of harmful sulfide phases, and the uniform formation of strong sulfides in the entire temperature range of metal solidification. The manufacturability of superalloys can decrease at a too high calcium or magnesium content because of the formation of intermetallics with a low melting temperature along grain boundaries.

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Software Package. Thermodynamic Calculations of Phase Diagrams for Multicomponent Systems . http://www.thermocalc.com.

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OAO Metallurgical Plant Elektrostal’, Elektrostal’, Moscow oblast, Russia

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On the Centenary of Plant “Elektrostal”

Original Russian Text © I.V. Kabanov, E.V. Butskii, K.V. Grigorovich, A.M. Arsenkin, 2017, published in Elektrometallurgiya, 2017, No. 3, pp. 13–21.

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Kabanov, I.V., Butskii, E.V., Grigorovich, K.V. et al. Simulation of the sulfide phase formation in a KhN60VT alloy. Russ. Metall. 2017 , 447–453 (2017). https://doi.org/10.1134/S0036029517060106

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Received : 21 November 2016

Published : 23 September 2017

Issue Date : June 2017

DOI : https://doi.org/10.1134/S0036029517060106

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