Elmore Kittower was 80 when he died in November 2007 at Silverado Senior Living, an assisted-living facility in Calabasas. His death was initially attributed to natural causes; at the time, a sheriff’s deputy told Kittower’s wife of 49 years, Rita, that her husband had “just stopped breathing.”
But after an anonymous whistle-blower tipped off authorities, Kittower’s body was exhumed, and experts found that he had suffered multiple broken bones and blunt- force trauma. The injuries were cited as a contributing factor in his death, and it was soon revealed that a Silverado employee had inflicted them.
The grieving family was left devastated, and the company — one of the premier senior living facilities in the country — was left to sift through the facts to figure out what went wrong.
“We had to look at what we have in place: hiring practices, retention, training,” said Anne Ellett, Silverado’s senior vice president. “We had to put everything on the table, and had weeks-long self-reflection as a company.”
Silverado Senior Living, which has 20 assisted living facilities in four states, is priced well above the national average — residents pay nearly $6,000 a month, compared to the national median cost of $2,575 per month, according to the Assisted Living Federation of America, for a one-bedroom apartment in an assisted living facility. Silverado residents, many of whom have dementia, are given more control over decisions about what to do and how they spend their time, and registered nurses are on site 24 hours a day.
But after Kittower’s death, it became clear that even upscale amenities can’t ensure residents’ safety. Subsequent revelations in court found that Kittower wasn’t the only resident abused by former employee Cesar Ulloa, who was accused of slamming his body into an elderly woman and laughing as he punched another resident in the stomach.
In May 2010, Ulloa received six years in prison for elder abuse and a life sentence for torture.
Steve Winner, Silverado’s chief of culture, said that elder abuse is a tragedy that’s nearly impossible to prevent. Ulloa passed all the tests given by the company in advance of his hiring, he said, including a background check and tests that screen for drug use.
He was so adept at “faking it,” Winner said, that families of other residents hoped he would be acquitted of the abuse charges and given his job back.
“We had families that said, ‘If he’s cleared, can you bring him back on?’ ” Winner said.
Elder abuse is a problem that’s getting worse nationally. Between 2000 and 2004 alone, reports of elder abuse increased 19.7 percent — from 482,913 to 565,747 — according to the National Center on Elder Abuse, a government agency. The organization estimates that for every one case of abuse reported to authorities, another five go unreported.
If outright prevention is difficult to achieve, though, Silverado claims to be doing everything it can to catch abuse sooner.
Among the company’s initial efforts to ensure swift reporting of abuse was the installation of an anonymous 24-hour hotline for staff (it later came out in court that other employees knew about Ulloa’s actions but never reported them). The facility also implemented new background checks and personality tests for prospective employees.
“It’s amazing how some people answer” the honesty tests, Winner said. “Sometimes bad behavior is so ingrained in your personality that you no longer even recognize it as being a negative trait.”
The facility will also work to uncover personal issues that might be affecting employees.
“Caregivers can be affected by outside stressors — and when we know that that is happening, we can be sure that those people aren’t working with” residents who might trigger those stressors, said Shannon Ingram, Silverado’s senior director of marketing and communications.
The organization now offers staff one-on-one meetings with social workers, during which staff members can talk about pressures they’re facing in their personal lives and learn ways to handle feelings that might be triggered at work.
Even with all these precautions, finding the right kind of employees to work with dementia patients isn’t easy, said John Danner, clinical social worker at the Memory and Aging Center at USC.
“It’s extremely difficult to recruit people to work in assisted living and nursing homes,” he said. “Since most of jobs are pretty low-paying, it’s a challenge to get people who are good at it and who see it as a career.”
Recently, Silverado also added a somewhat irreverent component to its approach, inviting author Derek Munson to speak to the staff. Munson is the author of “Enemy Pie,” a children’s book that deals with bullying.
While the book may be a bit far-fetched in terms of its link to elder abuse, executives at Silverado — as well as Munson himself — believe that the collaboration represents a mutual philosophy.
“ ‘Enemy Pie’ is about bullying for kids, and it talks about how to recognize a bully, how to react to it — and, in many ways, abuse is a bullying tactic as well,” Winner said.
When it comes to helping people with dementia, though, the most important qualities in caregivers may simply be compassion and patience.
“I believe that everyone with dementia is trying to make sense of the world, and it’s a frightening situation,” Danner said. “If someone isn’t able to handle that, then they shouldn’t be hired.”