‘Harmful Yet Largely Invisible:’ Resident Fear of Staff Highlighted in Recent Report

Nursing home residents say they fear retaliation from staff for voicing their concerns – and asking for care and services to which they’re entitled – leading to unnecessary emotional, psychological and physical harm.

Exacerbated workforce challenges play a big role in staff-resident relationships, as staff are “put in a position to fail residents” due to dangerously low staffing levels and high turnover rates, according to a study conducted by the Long Term Care Community Coalition (LTCCC) and covered by USA Today.

“There are real fears here that, at the end of the day, there’s going to be retaliation,” aging and long-term care expert David Grabowski, a professor of health care policy at Harvard Medical School, told USA Today. “I do think the vast majority of staff members are good people working hard, and many of them are underpaid and undervalued. But I think these issues come up, and when they do, they should be addressed.”


Eilon Caspi, lead researcher for the LTCCC study and assistant professor at the University of Connecticut Institute for Collaboration on Health, Intervention and Policy, along with a team of other researchers, highlighted this phenomenon as a “harmful yet largely invisible source of resident suffering.”

The study is meant to be exploratory in nature while also representing the most in-depth examination of resident feat of staff retaliation to date, Caspi and team said.

LTCCC collected 100 standard surveys and complaint investigation reports between 2017 and this year, on nursing homes across 30 states for the study.


Coupled with subpar staffing levels and turnover, nursing homes are hiring “unqualified or poorly vetted” staff to provide care, researchers said.

“Too many nursing homes are prioritizing profits over people, failing to invest in sufficient and qualified staff that can meet the needs of their residents,” according to the study. “When nursing homes are not sufficiently staffed with trained and qualified employees, their residents are at greater risk of poor outcomes, including the phenomenon covered in this project: fear of retaliation.”

Researchers added that many direct care workers are caring, compassionate and hardworking, and strive to keep residents safe while working in difficult conditions. But, too many nursing homes continue to foster environments in which mistreatment and retaliation against residents is tolerated.

Currently, the Centers for Medicare & Medicaid Services (CMS) doesn’t track standard survey and complaint investigation reports containing violations related to resident fear of staff retaliation, according to the report.

Researchers went on to say that the agency doesn’t track such reports on threats of retaliation, perceived retaliation or substantiated retaliation.

“The wide range of circumstances identified in this project as underlying this phenomenon, combined with its serious and emotionally devastating effects on residents (described in residents’ own words), demonstrate the urgent need for such tracking,” LTCCC said.

The National Ombudsman Reporting System tracks complaints of retaliation, but not fear of retaliation, researchers said, in the form of voicing care concerns and grievances.

The organization suggested CMS develop a unique survey deficiency citation via an F-tag or other mechanism to really capture violations of federal laws and regulations related to fear of retaliation.

The agency should also launch a national campaign focused on educating and raising awareness among residents, families, nursing homes, state survey agencies, Ombudsman programs and other stakeholders, according to the report.

“An effective campaign could ultimately help restore residents’ trust and confidence that they and their families should never have to fear staff retaliation when speaking up about care concerns and mistreatment in their home,” said researchers.

LTCCC pointed to Connecticut as an example of policy to combat fear of resident retaliation with the passage of An Act Concerning Fear of Retaliation Training in Nursing Home Facilities.

The legislation requires annual in-service training consisting of discussion of resident rights to file complaints and voice grievances, providing examples of what might constitute or be perceived as employee retaliation, and outlining methods of preventing employee retaliation.

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