Case of local nurse aide accused of abuse set for review

By Elizabeth Simpson
The Virginian-Pilot

The case of a nursing home aide accused of committing a string of violations in four Virginia Beach facilities is scheduled to be reviewed Wednesday by the Virginia Board of Nursing.

The allegations against Patricia Annette Dukes Moore include abuse of residents and span more than five years in Virginia. But the incidents were only recently investigated by the board.

"Unless someone reports an incident, you can't take action," said Jodi Power, deputy executive director for the Virginia Board of Nursing and manager of the nurse aide registry. "You can't act on something you don't know about."

Advocates for the elderly say high turnover rates of nurse aides and a porous screening network allow caregivers with questionable work records to move from one facility to another.

The allegations against Moore, contained in a report written by a Board of Nursing investigator, include:

n Bruising the genitals and groin area of a patient.

n Grabbing the genitals of two male residents.

n Having an inappropriate relationship with a resident and showing him her underwear.

n Cursing at residents and threatening not to clean them.

n Throwing a resident's bread and silverware.

n Testing positive for marijuana use, and being diagnosed with a mental health condition that requires medication and treatment.

Moore worked as a certified nurse aide at one assisted living facility and three nursing homes in Virginia Beach between the summer of 2001 and Jan. 2 of this year.

The investigator also reported an alleged incident of abuse eight years ago at a nursing home in Biloxi, Miss. The report said Moore grabbed a resident by the hair and slammed the woman's head into the side rail of the bed, and left a bruised area on her forehead.

Moore was fired as a result of the incident, according to the report.

Joani Latimer, Virginia's long-term-care ombudsman, said abuse in nursing homes often goes unreported because residents fear retaliation. In situations involving sexual abuse, residents often are ashamed of what happened and don't tell anyone.

And residents with dementia don't make good witnesses when they do report an incident.

Richard Mollot, executive director of the Long Term Care Community Coalition, based in New York, said low pay, poor training and overworked staff can lead to high turnover rates in long-term-care facilities. That, in turn, opens the door to nurse aides "flying under the radar," he said.

Moore currently is not flagged on state nursing registries in Virginia or Mississippi as having any disciplinary actions taken against her.

That could change Wednesday, when the Board of Nursing meets. Moore had the opportunity to address the allegations at a meeting in August, but she did not show up.

Moore could not be reached by The Virginian-Pilot. A certified letter sent by The Pilot to the Virginia Beach address listed on her nurse aide hearing notice was returned, and a telephone number at the address had been disconnected.

Power said the case reflects the importance of reporting code violations as soon as possible.

"Anyone can report an incident," she said. "It doesn't have to be the nursing home."

In letters delivered by The Pilot to the four Virginia Beach facilities where Moore worked, officials were asked why she wasn't reported. Two facilities - Heritage Hall and Beacon Shores - did not reply to the letters or to phone calls.

Officials at the other two facilities - Atria, a Virginia Beach assisted living facility, and the Virginia Beach Healthcare and Rehabilitation nursing home - responded by e-mail that they can't discuss specific cases of employees because of confidentiality of personnel records.

Representatives of those two facilities said they report incidents to the proper licensing boards when violations are identified. They also said they do background checks on new employees and call previous employers.

"Unfortunately, we are limited to information that past employers share," wrote Michelle Hinners, administrator of Virginia Beach Healthcare and Rehabilitation in an e-mailed response. "For example, some will only share dates of employment."

Screening new employees is a struggle for all facilities, according to Stephen Morrisette, president of the Virginia Health Care Association, an organization representing nursing homes and assisted living facilities.

"We are no different from any other employer," he said. "It's difficult. You can only go so far. People can be sued for giving a negative reference."

Another problem: Job applicants don't always reveal where they have worked.

Moore's list of alleged violations include several that involved incorrect information on job applications, including stating she had never been disciplined or terminated for abusing a patient, and failing to list a complete record of previous employers.

That's considered falsifying records, a state code violation that could lead to revoking certification.

And even when a violation is reported to a licensing board, the investigation process takes time. During the last fiscal year, it took about 10 months, on average, for the Board of Nursing to close a case.

That was a 9 percent increase from the previous year. Power said performance goals that Gov. Timothy M. Kaine established earlier this year could be one reason. "You have to find the old cases, and resolve those, so there's going to be a dip before there's improvement."

Even when a potential employee has a criminal record, that doesn't always prevent him or her from finding work in the long-term-care field.

For one thing, a facility can take as long as 30 days after someone has been hired to complete the background check.

"Theoretically (and in reality I believe), an employee with a criminal history could work a few weeks at this facility, then move on to the next, and carry out that pattern somewhat indefinitely," Latimer wrote in an e-mail response.

Also, she wrote, "In some instances, the vigorousness of the facility's efforts to do a thorough check may be tempered by its desperation to fill that empty position."

According to a 2002 American Health Care Association survey, the annual turnover rate for CNAs - the number of employees who left their job divided by the total number in those positions - was 73 percent in Virginia. People in those positions make about $10 an hour, according to statistics from the Bureau of Labor Statistics.

"They need them so badly and pay them so little that if they have a live body, they'll hire them," said Kathleen Blanchard, founder of the Greater Hampton Roads Coalition on Aging.

That coalition has been lobbying the state for years to increase the pay and benefits of nurse aides, and to set up minimum standards for how many residents one nurse aide should care for.

The coalition also wants to extend background screening to include national checks, not just state, and to increase the number of "barrier crimes" that can eliminate people from the caregiving field.

Barrier crimes include all felonies and misdemeanor crimes that involve lying, cheating or stealing. People who have a chemical dependency or mental condition that would impair their work also can be restricted from getting certified.

The board reviews these applications on an individual basis.

Power said she would not consider the Moore case a typical Board of Nursing investigation.

"She has three pages of allegations," Power said. "Most of the notices aren't that long."

On Wednesday, the board will review the recommendation made by an officer who reviewed the case in August. The board can accept or modify it, reject it or call for another hearing. The board's decision is a final order, but Moore can appeal it in Circuit Court.

The board can take a variety of actions, including exonerating her or prohibiting her from ever working in a long-term-care facility that receives Medicare or Medicaid funding.

Of 275 actions taken in nurse aide cases in Virginia during the last fiscal year, 10 certifications were revoked and 60 suspended. There were 71 reprimands.

But being disciplined by the state doesn't mean the employee won't return to another type of caregiving job.

Nursing homes and home-health agencies that receive federal funding through sources such as Medicare and Medicaid must have licensed or certified caregivers. However, that's not a requirement of all assisted living facilities jobs, a field that's growing much faster than nursing-home care.

While many assisted living homes do hire certified nurse aides for direct care, regulations allow the facilities to hire people who have only completed a training course.

Also, new agencies have been springing up both here and nationally to provide in-home care to older and disabled people. That care is considered "personal assistance" - not nursing care - and is not as strictly regulated.

Mollot said the baby boomer generation is much more inclined to want to age at home, and there's a national movement to increase such opportunities. But he's concerned about the risks.

"If you think it's hard to track people in licensed nursing homes that have inspections every year, think about inspecting every caregiver in every house for stealing, abuse or neglect," Mollot said. "You are much more open to abuse there, because it's just you."

Chesapeake resident Martha Scott found out the hard way when looking for in-home care for her 86-year-old mother. While one caregiver she hired "walks on water," another lied about whether she had nurse aide certification.

She urges people to do their own detective work by checking out references and running them through the Board of Nursing Web site, which lists licensed and certified caregivers.

"You can verify if they are licensed and what they're licensed for," Scott said. "Some do what they're supposed to do, but others try to squeeze by the system."

Elizabeth Simpson, (757) 446-2635, elizabeth.simpson@pilotonline.com