Saturday, November 22, 2014

If a tree falls in the forest: Rape vs. dementia

    If a tiny, 96-year-old woman with dementia -- who has lost the ability to form new memories -- tells a nighttime  aide that she has been raped, but has no recollection of it the next morning, should any "sound" be made about it? Should we care? She is eating her eggs and bacon and talking about her love of "smooth jazz." What's the problem, Sylvia? Why don't you back off, instead of making a big deal out of nothing?

"It was probably just a garish dream."

    I received a calm, low-key phone call from the Executive Director  (ED) of the dementia facility at 9:15 a.m. on Wednesday, Oct. 1, informing me that my mother had reported being “raped and beaten” at 4:30 a.m. that morning. She was "just fine" now, he added. He suggested that I call the Reminiscence Director (RD)  if I wanted the police to be notified.
    Of course I wanted the police to be notified! Hours ago, you fools!

       The RD said she wasn’t informed of the allegation until she arrived at about 8:30 a.m. She was told that a NOC (overnight) aide had entered my mother’s room to check on her, and discovered that she had wet the bed, which I’ve been told happens several evenings a week. My mother told her that a man had entered her room and raped her.
     "Your mom doesn't remember anything about what happened. So you really think we need to get law enforcement involved?"
     YES I DO, GODDAMIT. There I went, ”being "disruptive," as usual. The RD sighed.
    Why did they permit hours to go by, during which any physical evidence – from fingerprints to seminal fluid -- could be compromised, contaminated, wiped off, laundered, discarded or in other ways rendered unusable/inadmissible?

    I am very surprised that my mother shared information about the assault with the overnight aide. She is so modest, so private and so proscribed by the sexual conventions and propriety of another century, that I wouldn't  have expected her to tell anyone, even a doctor or her family, unless she was so traumatized that she couldn’t control herself.

    The aide’s response to my mother’s recounting of this devastating and intimate experience was to “clean her up,” change the bed linens, get her into an adult diaper and dry pajamas, and put her back to bed, I was told by the RD. 
    Does this sound to you like the appropriate way for a potential crime scene and crime victim to be handled? It is the ideal way for a crime scene – and a crime victim -- to be sanitized into uselessness.

    Thus did a low-wage aide take it upon herself to ascertain the credibility of a serious criminal charge. I cannot imagine any context in which this would be considered appropriate policy. 
     It is obvious that to the extent that ANY debriefing or investigative interview can elicit accurate information from a dementia patient, time is of the essence. If the facility  had a policy of protecting residents, and respecting their safety, a recorded statement from my mother would have been taken immediately, and the police would have been summoned immediately. 
     Instead, my mother was treated so dismissively by NOC staffers that she expressed anger and distrust, which is not normal for her. She was sent back to bed, and the whole matter was set aside for FOUR HOURS, until the RD arrived, and even then, no decisive, compassionate, respectful action was taken until I insisted on some follow through.

    (When I later complained to the ED about the cavalier trashing of evidence that could have proven or disproven my mother’s claim, he was extremely hostile and defensive, claiming that “of course” his staff had “bagged and tagged” everything, and provided it to the police for forensics analysis. “We’re not stupid!” he hissed at me).

    Since I was well aware of the ED's chronic lying, I called the police to determine whether he was being honest with me. The police stated unequivocally that the facility had provided them with no forensics evidence whatsoever.
    (Indeed, it would have been ‘highly inappropriate’ for an aide to “bag and tag” the evidence, a detective said. The room should have been secured immediately, and the police should have been summoned promptly. They are the “experts” in the handling of evidence, she said. They and only they should have had contact with the room and its contents.)

    In any case, it appears that all forensics evidence that could have corroborated or cast doubt on my mother’s claim was destroyed or catastrophically tainted.

    I have never said the ED is stupid. I have said he is a liar, and this was another of his absolute lies.

    How can the multinational corporation that owns this facility afford to have such a person at the helm of a complex operation in which so much is at stake for so many people?

    Back to the night of the episode: My mother – and this is also uncharacteristic of her – got back out of bed after having been cleaned up, and made her way to the office (which she usually can't even find) to repeat her complaint, an added dimension of her distress which I learned about only after acquiring the log report, which described her as “emotionally upset.” (None of this drama was conveyed to me by either the ED or the RD, who implied that my mother said, “I’ve been raped,” and then slipped right back into bed.)

    “We talked to her, but she cried,” the aide wrote.

    What do you think they said to my mother? Probably something like: “It was just a bad dream.” That isn’t for them to decide. And, as I will describe later, my mother has always said she doesn’t remember her dreams. No wonder my mother “got angry at us and didn’t trust us,” as the aide reported in the “confidential” log report I was finally able to obtain. .


    When my mother was roused the next morning to get ready for breakfast, she seemed “cheerful and happy” and “looking forward to a beautiful day,” the RD told me during our 9:20 a.m. conversation. 

    (This is a lie, as I will detail below, and part of the institution's script, in which all residents’ families are assured by all staff members all the time that their loved ones are happy, cheerful and having beautiful days. It is a corporate-wide strategy that is chillingly manipulative and dishonest. 
    This is a paranoid, self-deceiving, controlling and byzantine culture designed to keep the millions of dollars pouring in (the company netted $40 million in 2012).
    The RD's bias was clear: Let's forget about it, just as my mother has.

    I have tried so many times to accept the conclusion that everyone else seems to have pounced upon: Nothing happened to my mother, or probably nothing happened to my mother. Of course, that’s what I want to believe. But there is NO OBJECTIVE, INTELLIGENT BASIS ON WHICH TO MAKE THIS ASSUMPTION. She said something happened. Then she said she couldn’t remember that anything happened. THAT’S NOT A RECANTING. THAT’S DEMENTIA.

    Over and over again, every day, my mother forgets what just happened to her. I can spend the whole morning with her, having delightful conversation, and within 10 minutes after I get home she calls to ask why I never come to see her anymore. 
    The “Reminiscence” domain is filled with people who are doing very little all day besides forgetting.


    There is only one way in which my mother’s case could have been responsibly handled. It would have required that the corporation adopt and enforce an explicit, rigorous protocol for addressing serious and/or criminal allegations. The facility blatantly botched everything, either by not having a policy, or by ignoring it completely.

    Think what a hassle it would have been to pursue this to its logical end point. Think of the ripples of gossip and fear within the institution. Think of the ramifications if my mother had verifiably been assaulted: News coverage, legal concerns, disarray and dismay among the headquarters honchos, a PR nightmare. Heads might have rolled.

    I finally was able – for the first time in four months—to get a daily log report on an aspect my mother’s care, after staring down three flustered, panicky higher-ups.

    I’m not surprised that the facility wants to keep the goings-on in its facilities “privileged and confidential – for internal use only.” This policy, as I have said before, is not legally defensible. At the very least, those who have POA, and very likely other close family members, have the right to read all logs and medical records pertaining to the loved ones they have entrusted to the facility's  care. 
    How can anyone possibly defend “classifying” this material as secret? We OWN it. We are paying for it. And the facility has no right to keep anything from us regarding the well-being of our parents.

    The emotional aspects of my mother’s ordeal – her crying, her distress, her persistence – were never conveyed to me by the ED or RD, for obvious CYA reasons. For me, the log report added a new level of depth and seriousness to the case that was totally glossed over by the executive staff.

    I am particularly interested in the fact that my mother did not report the rape until after she had used the bathroom, according to the “classified” internal report. Perhaps there was pain or burning or discharge that brought the episode back to life in her mind.

    The detective who got the case following a preliminary interview by an officer characterized the institution's failure to summon law enforcement immediately as “meeting all the criteria for elder abuse.”

    This is not a conclusion that would ever have occurred to me, but she said children and the elderly are “protected populations” that are covered by different rules, and the facility violated “all of them,” she said.

    My mother’s cry of “rape” should not have been discounted just because she has dementia. It was discounted, though, because it was inconvenient, messy and potentially disastrous from a liability perspective, and her memory lapse provided an excellent “cover” for the institution. The aide’s note that the door had been locked all night can’t be taken at face value. She could have been protecting herself, since the door is supposed to be kept locked, or the institution, or even a male aide who also had access to the keys. 
     The RD and ED know very well that my mother has experienced extreme physical and emotional trauma during the past nine months – involving terror, enormous amounts of blood, serious falls, ambulances, and very stressful hospitalizations, and she has no memory of any of it. She still doesn’t recognize the woman with whom she has shared a suite for five months. She doesn’t remember where the bathroom is in her own suite – she keeps opening kitchen cabinets, saying, “I need a toilet now. 
     So her failure to remember a possible assault is simply irrelevant, except to those who want the problem to disappear.  

    It was surely in the interest of the corporation for this matter to be dispensed with. Its liability is clear. Residents are not able to lock their bedroom doors – something that shocked me the day I went there to move my mother’s belongings into the room she would soon occupy.  An afternoon aide told me that the overnight aides “try to remember” to keep the doors to each two-bedroom suite locked, in between their regular bed checks. Men and women are housed on the same floor, and – as I have repeatedly noted – I have found men alone in my mother’s room several times during the day when I entered to see if she had left yet for breakfast. On several other occasions, men have followed the two of us into her living quarters. (One of them did so again on Saturday, Oct. 4, after having just told me in the dining room, “You are so pretty, I better not talk to you anymore.”) I have firmly told them, “This is for women only. No men allowed,” and slammed the door. It’s not their fault, of course, that they fail to remember my warning. 

    It is absurd to state with assurance that any man – whether he’s got dementia or not – is “harmless” and “poses no risk.” We don’t know that. The facility fails to meet its obligations to protect the safety of its residents when it permits this kind of free-roaming among people’s rooms. And any solitary person who lives in such a vulnerable situation deserves the right to lock her door when she is in her room. The aides would obviously have keys, and could enter whenever it was necessary or appropriate. 
    The RD used what she referred to as my mother’s good mood the morning after the alleged assault to discount the allegation. The RD has told me several times over the past four months that my mother had been “cheerful and happy” when she got up that morning, that she was “laughing and pleasant” and “looking forward to her day.”  
    I know my mother. She has never arisen in this state of mind. She has always – since I was a child – been one of those people who is irritable, claustrophobic and confused for quite a while after she gets up. I have apologized to several aides about the way she has treated them (Many times when I have approached the room to escort her to breakfast, I have heard her yelling at the aides that she doesn’t want to get up, and that she should be able to stay in bed as long as she wants to, which is understandable. It wasn’t her idea to be institutionalized. She wants to run her own life. She lashes out at the aides, telling them to leave her alone, “get out – I don’t need any help.”) 
    I am very sorry for the aides (although I place no blame on my mother – she is devastated that she is no longer the master of her own fate). The aides tell me that many of their other charges behave in a similar way, and that they don’t take it personally. They are great people.

    The RD said even if we have normal thoughts during the day, our dreams can involve murder or “being eaten by animals.” My dreams (which I do clearly remember) certainly don’t. I have asked my mother several times about her dreams, both before and after she got dementia. She has always said that she has no memory of ever having dreams. Since my dad died, and she’s lived alone, I asked if she ever has frightening or morbid thoughts during her bouts of insomnia. She said no, she has no thoughts at all that she’s aware of.

    As her dementia has evolved, she has had what I would characterize as delusions and fantasies during the day that come from “living inside her head.” In all of them, the men who populate this waking-dream-world are either pleasant and considerate, or they are oblivious to her. Even when she was at home, when the dementia first became evident, she fantasized that there had been men coming and going all day, doing various things on all three floors….she didn’t remember what.... but she was sure it was important. 
    “I didn’t mind them. They seemed nice,” she said.     

    When she was at an assisted living facility for a couple of months, she believed, in her demented mind, that large groups of foreign men were partying each night, just outside her unlocked bedroom door. But none of them ever attempted to come into her room, to engage with her, or to threaten her in any way, according to her. They just disrupted her sleep. She did blame the fact that her bed was soaked with urine on men who entered her room, lay down in her bed and peed – but she never said any of them had touched or talked to her. Her response was to move to the other – dry -- side of the bed and go back to sleep.

    At the dementia facility, a carload of strangers arrives “like magic” whenever she needs a ride to her house or to her “job” at the University Hospital, she tells me. I said, “Aren’t you afraid to get into a car with people you don’t know?” Her reply was, “Of course not – they are just trying to help me.”

    She has never ascribed hostile or dangerous motives to any of the stream of men in her very active “life inside her head,” and she has never expressed any fear about her unlocked door. She has a good heart, and she assumes others do as well. She has never voiced concern about being a crime victim. In recent years, she has called upon the kindness of strangers to help her out in ways that I would not have dared do. When itinerant workers, doing day labor in her yard, have acted in a physically intimidating fashion toward her, she never feared sexual assault. Robbery, perhaps. Being knocked down at the worst.


    While it is possible – and most would perhaps say likely – that my mother dreamed she was raped, there is good reason to question that. She is not a sexual person. More pertinently, she believes that her body is so old, saggy and wrinkled that any man – including a doctor – would be horrified by the sight of her. She regards rape as a sex crime (as most people still do, despite the expert consensus that it is a crime of violence and domination). And she cannot conceive of being an object of sexual interest. Because we have discussed her feelings about her old-lady unattractiveness so many times over the years, I am less able than others are of blithely dismissing my mother’s “rape experience” as a dream.

It is pointless to speculate about what happened. Because of my mother’s mental condition, the only conclusive evidence we could ever have hoped to get (unless witnesses surfaced) would have been physical.

    If the facility had cared about my mother, and about its other female residents, as much it cared about its reputation, its neurotic obsession with concierge-style “propriety,” and its liability, it would have gently and lovingly encouraged her to permit a physical examination. That way the issue would have been resolved, rather than being swept – with great relief all around – under the rug.

    It was the only way to resolve it, and it wasn’t done. I am appalled by the moral laziness that caused my mother’s highly uncharacteristic outcry to be tossed into “the garbage bin of history.” Who cares? What does it matter?


     Regarding the police issue, I said of course I wanted them called in, and that I wanted a female law-enforcement person to speak with her and try to elicit any evidence that would shed light on this matter, even though it would probably be a total waste of time, now that so many hours had elapsed. 
    I told the RD, DeAnn Jansen, that I would like to be present during the interview, but perhaps my mother would speak more freely if no one else was present – that way, she wouldn’t have to worry about hurting, worrying, angering or embarrassing anyone. “I think that’s a very good insight,” the RD said. 
    The thought of my 96-year-old mother coping with this by herself broke my heart, but I resisted the impulse to rush to her side, and stayed home, waiting for an update. (In a characteristically treacherous move by the RD, she ignored her own advice to me and assembled four people to attend  the interview with the officer, all of whom wanted to get the whole thing out of the way and go back to normal life.  I have no doubt that all that "peer pressure" was keenly felt by my mother. )
    This gang scene wasn’t tantamount to rape, but it was tantamount to intimidation – or at least extreme discomfort and guilt – from my mother's perspective. She just wants to get along, and not to create a problem for anyone. 

    No one from the facility or the police department called me about the interview, so I called the officer myself. Officer Allen said my mother apologized for creating a problem, and said “I can’t believe I said those things,” and denied that anything had happened to her the night before. She said she was “just fine.”

    This doesn’t surprise me. She would probably have brushed off the whole thing even if she remembered it. She is a very private person. She can’t bear the thought of creating a scene or causing trouble. She is still molded by the era in which rape was regarded as a crime of unbridled passion – and in which the victim was often blamed and shamed (she was asking for it), if she were believed at all.

    Anyway, this is all tangential, due to her inability to form new memories. The only way to get to the truth would have been for her to be examined.


    The officer said she asked my mother if she would be willing to submit to the rape-kit process, and my mother declined.

    “Did you try to reason with her, to reassure her, to use some gentle persuasion?” I asked.

    “Forcing a person to submit to the exam is tantamount to rape itself,” the officer replied sternly.

    Of course it is. I would never ask that my mother be forced to submit to any exam. But she can be reasoned with. I spend 10-15 hours a week talking with her. She has a good mind. She understands complexities and still has a great sense of humor. She asks insightful questions and expresses compassion for those who seem to be lonely or distressed. She can have a change of heart about a person or issue if she is provided with a reasoned explanation. We go through this process all the time together. She has a will, she has dignity, and she has a sense of responsibility.

    In other words, she can change her mind, if one takes the time to explain the pros and cons.

    I desperately wish I had been present. Since the officer wasn’t inclined to advocate the examination, I would have explained the benefits to her, of resolving this once and for all, and particularly of preventing any other woman from having the same experience by the perpetrator involved. I believe she would have relented if I told her I would be with her.

    To those who might believe that it’s better if my mother doesn’t know that she was raped, so we’re better off dropping the whole thing, the answer is obvious: If she can’t remember the rape, why would anyone believe she would remember an examination, or its findings?

    I feel betrayed by the fact that Officer Allen blurted out to me that the RD told her I had “implanted in (my) mother’s mind” the fear of being raped. 
    That is a lie, and a cruel one. I have warned my mother about the excessive warmth and physical affection she expresses toward a man whom she believes to be the husband of a dear friend. I remind her regularly (since she forgets) that men – demented or not – tend to misinterpret such cues as romantic interest. I have simply asked that she be careful and not “give him the wrong impression.” I have not used the word “rape” with her, but – as I’ve said – I have believed from the start that the third-floor security, in a co-ed living area, is dangerously lax. 
    My mother’s obvious fondness for man is a prominent enough factor in her day-to-day existence at the facility that it has been mentioned in at least two of the three cursory “service and health updates” I’ve received about her so-called life at the there.  

    Anyone who keeps up with the news realizes that romantic relationships, sexual relationships, sexual assaults and STDs have become an open issue at assisted living facilities ever since Justice Sandra Day O’Connor’s husband “fell in love” in a dementia facility. 
    My concern is not that my mother is falling in love. In fact, I’ve told her several times since my father died that I believe she is capable of experiencing romance, and that I wished she had an enjoyable escort/companion. She refuses to consider it. And she would never harbor such feelings toward a man whom she resolutely believes is not just married, but married to a best friend.    
        Four days after my mother said that she had been raped,
(on her 96th birthday) the ED informed me that the officer who investigated my mother’s emotionally charged allegation had determined it to be “unfounded” and had closed the case. 
    The ED’s assertion that the case had been discredited and closed was yet another of his lies, as I learned days later, when a detective told me she had been assigned to proceed with it.

    The ED responded to my questions about critical discrepancies between his account of how the incident was handled and the account I received from his RD by saying “the matter has been resolved. I am busy.” He brushed aside my questions about gaps in the investigation by saying, “The police are the experts. We defer to their expertise. They know what they are doing.”

    Several days after the alleged rape, I discovered a foamy, viscous fluid on my mother’s bed skirt and on the carpet. Had there been "another" incident?  The ED assured me that he would send samples to the police forensics laboratory. 
    Once again, this was a lie, as I confirmed by calling them two days later. The police did not receive this fresh material, nor did they receive any information that possible new evidence was available. In fact (strangely enough), the stained sheets remained in a plastic bag, tossed onto a large dog bed in the ED's office, for a month or more.
Look familiar?

    On Thursday, Oct. 10, the detective called to tell me she was closing the case. She said there was no body of evidence on which the DA could build a viable prosecution.    
    Of course there wasn’t.

    I am not closing this case. I am keeping it open right here, where it will be read by thousands of people and linked to dozens of blogs. 
    People with dementia are so vulnerable. You don't fully realize it until someone you love succumbs to this disease. They have no way of knowing what has been done to them, or what hasn't been done for them. My mother's experience was yet another example, albeit the most appalling one to date, of how a corporate institution will say and do whatever is necessary to protect its interests, irrespective of its residents’ well-being.