Choosing to place a loved one in a nursing facility takes a lot of trust. What happens when that trust is violated and your mother ends up in a Snapchat video? Learn what happened to Margaret Collins and weigh-in on how cases of abuse and neglect against the elderly should be handled.
Leaving your mother or grandmother in a long-term care facility is challenging. For one Illinois family, it turned into a nightmare. A video taken in December of 2018 showed two certified nursing assistants taunting resident, Margaret Collins with a hospital gown. Jamie Montesa and Brayan Cortez posted a video to Snapchat that showed them repeatedly throwing a hospital gown on top of Collins with the caption, "Margaret hates gowns.” Collins, who has dementia, waved the gown away each time.
Collins not only had the right to participate in her care, but she also had the right to refuse it. She clearly did not want the hospital gown. One could argue that she was agitated at the time. Even if this were true, she didn't have to wear the gown and could have been dressed in her own attire.
Right to privacy and confidentiality
Collins had the right to keep the details of her care private. Having a video of herself posted on Snapshot without her or her designee's explicit consent is a direct violation of this right.
Right to dignity and respect
Treating any human in the manner that Montesa and Cortez treated Collins greatly lacks both dignity and respect. She also has the right to be free of mental and physical abuse and to determine what activities she wants to participate in during her care. Both of the nursing assistants disrespected Collins in this case.
Right to make independent choices
Residents living in healthcare facilities have the explicit right to make decisions about what they want to wear or eat and how they want to spend their free time. Their choices should be accommodated and respected by all caregivers.
Legal Implications and Disciplinary Action
The two nursing assistants were initially given a six-day suspension. After further investigation into the incident, the facility determined that they violated internal policies and standards. Montesa also admitted to previously recording a video of Collins while she was in a wheelchair. When the investigation concluded, the two workers were terminated. In a statement, a representative from the facility said, "The privacy and dignity of our residents are of the utmost concern.”
The family of Margaret Collins is reportedly suing the Abington for $1 million in damages. The parent company of the facility and the two nursing assistants are also named in the suit. Collins has been moved from the facility. The family reported that she suffered from anxiety related to the incident.
Is Termination Enough?
Most people will agree that Montesa and Cortez received what they deserved when they were terminated. However, is it enough? During a search of the Illinois health care worker registry, it appears that both Montesa and Cortez remain certified in the state of Illinois. No administrative filings are on record for either worker. Of course, it can take months or even years for cases like these to come before the regulatory boards. These gaps in time could leave other vulnerable individuals in similar situations.
The incident with Collins leaves me wondering how difficult it would be to formally suspend a healthcare worker who is terminated for abuse or neglect. Could this be done? And, if it's done in error, what are the repercussions to the worker?
Cases like this may become more common as more people live longer with debilitating conditions such as Alzheimer's disease or dementia. At some point changes, need to be made by the facilities, training programs, or states who certify and license people who care for the elderly.
What are Your Thoughts?
What do you think? Did Montesa and Cortez get what they deserved? Should they be allowed to care for others in the future? And, how would you respond if this were your mother or grandmother? Add your thoughts in the comments below. We would love to hear what you're thinking about this despicable act.
"What do you think?... We would love to hear what you’re thinking about this despicable act."
I think and ask myself: What motivated Montesa and Cortez to commit "this despicable act"?
Everybody has a need to feel power and control over any given situation. Had Margaret Collins donned the hospital gown she was offered, M & C probably would have went on their merry way. When Mrs. C refused the gown, M & C felt no sense of power or control and reacted accordingly with inappropriate behavior.
What caused that inappropriate behavior to occur?
When stimulated, our sympathetic nervous system stimulates the brain that makes a reflexive decision to take either fight or flight response. M & C made a reflexive decision to fight. Once a reflexive decision is made, a domino effect occurs and Newton's Law of Motion is in effect.
Unless an external force changes the state of a motion, the motion will remain in action. M & C had synergism in that the two were on the same course of action, which fueled the motion. If either M or C would have said something like, "You know- it's her right to refuse to wear a gown. Let's leave her alone", the external force would have changed the state of the inappropriate motion and the motion would have ceased.
In the early '90's, I learned that certain anticonvulsants were being used to help control explosive disorders. An explosive disorder contains features such as "sudden episodes of impulsive, aggressive, violent behavior or angry verbal outbursts in which (an individual) reacts grossly out of proportion to the situation".
A neurologist affirmed my belief that an explosive disorder episode is not unlike a seizure, in that neurons are stimulated causing an out of control chain reaction.
Did M & C both experienced an episode of an explosive disorder? No- but they both experienced the stimulus that caused the inappropriate behavior and both did not possess the internal governing mechanism to cause the behavior to cease.
Locking the barn after the horse is stolen and punishing the thief is tact to take in preventing a parochial future crime. However, understanding the motivation and actions behind the theft will universally assist in preventing many more like crimes.
You are right on here. I have worked with many fine aides in LTC however, there are some that were not as mature, have the self control or make good decisions as others.
So because you think this sort of behavior is common, it's ok?
What punishment accomplishes is that the perpetrators get punished.
They will either be bitter or they will realize the error of their ways.
Maybe their being punished will be a deterrent to others who might foolishly think this behavior is ok.
They need to be banned from "caring for " the defenseless population. That would be a more appropriate approach to the nursing home to have taken with them, in addition to firing. You know, reporting them to state regulators.
I can't believe you think that this kind of thing being common makes it ok. What if YOU were that patient? Your child? Your parent, grandparent, other loved one?
I don't think anyone is saying this is OK. Of course not. We have a problem in the US with caring for older Americans. Basically we as a population do not value these people. If we did, then this type of thing would not happen.
I don't know how we can change a culture but we can put measures into place that create an atmosphere where these types of situations don't happen. Honestly, it comes down to money, I hate it but that's where it's at. Just like so many other things in healthcare.
To answer the question, Yes, they should have lost their jobs for violating rules and regs. They should be rehabilitated.
I would have responded by asking for discipline and education. I would have been very angry and disappointed in the facility if it were my grandmother. I have taken care of many dementia patients that have tried my patience so I have an understanding of how this type of thing can happen, but I DO NOT CONDONE IT! Just making that clear.
As Forest 2 said - it comes down to money.which I think backs my original statements. Our society does not value our aged folks. Years ago I did SNF/ ALF facilities for hospice. Many patients told me to condense ' I am in a warehouse for old people's. And while some facilities are nicer than others, this is a largely accurate observation. These days too many places are looking for a warm body with proper credentials. That needs to stop. If you have no patience, no humanity, no compassion, don't get into this field. We already have enough problems
We (society) find it acceptable that these people lay in their own waste until someone is free to clean them, make them room with two other people, shower them once weekly and provide nursing care that ensures they will only get 5-10 minutes of face to face time with an actual nurse, if that. If all of that wasn't bad enough, we then employ staff members who are less than caring and in this field for god knows what reasons. (ive never understood why some CNAs choose this field when they clearly hate it - they pay certainly isn't what attracts them)
"What do you think?... We would love to hear what you’re thinking about this despicable act."
I think and ask myself: What motivated Montesa and Cortez to commit "this despicable act"?
Everybody has a need to feel power and control over any given situation. Had Margaret Collins donned the hospital gown she was offered, M & C probably would have went on their merry way. When Mrs. C refused the gown, M & C felt no sense of power or control and reacted accordingly with inappropriate behavior.
What caused that inappropriate behavior to occur?
When stimulated, our sympathetic nervous system stimulates the brain that makes a reflexive decision to take either fight or flight response. M & C made a reflexive decision to fight. Once a reflexive decision is made, a domino effect occurs and Newton's Law of Motion is in effect.
Unless an external force changes the state of a motion, the motion will remain in action. M & C had synergism in that the two were on the same course of action, which fueled the motion. If either M or C would have said something like, "You know- it's her right to refuse to wear a gown. Let's leave her alone", the external force would have changed the state of the inappropriate motion and the motion would have ceased.
In the early '90's, I learned that certain anticonvulsants were being used to help control explosive disorders. An explosive disorder contains features such as "sudden episodes of impulsive, aggressive, violent behavior or angry verbal outbursts in which (an individual) reacts grossly out of proportion to the situation".
A neurologist affirmed my belief that an explosive disorder episode is not unlike a seizure, in that neurons are stimulated causing an out of control chain reaction.
Did M & C both experienced an episode of an explosive disorder? No- but they both experienced the stimulus that caused the inappropriate behavior and both did not possess the internal governing mechanism to cause the behavior to cease.
Locking the barn after the horse is stolen and punishing the thief is tact to take in preventing a parochial future crime. However, understanding the motivation and actions behind the theft will universally assist in preventing many more like crimes.
We (society) find it acceptable that these people lay in their own waste until someone is free to clean them, make them room with two other people, shower them once weekly and provide nursing care that ensures they will only get 5-10 minutes of face to face time with an actual nurse, if that. If all of that wasn't bad enough, we then employ staff members who are less than caring and in this field for god knows what reasons. (ive never understood why some CNAs choose this field when they clearly hate it - they pay certainly isn't what attracts them)
Its horrible, it's got to change.
Yes, it certainly does need to change but I don't see it happening. What is one to do? Most healthcare people work all the time, how to "March on Washington" for the elderly. I don't see it happening. I would rather see my elderly family members live at home under almost any circumstance than be in a long term care facility.
I am pretty sure that some iffy people choose this as a job, because it pays better than minimum wage, sometimes training is free and it is job security.
"What do you think?... We would love to hear what you’re thinking about this despicable act."
I think and ask myself: What motivated Montesa and Cortez to commit "this despicable act"?
Everybody has a need to feel power and control over any given situation. Had Margaret Collins donned the hospital gown she was offered, M & C probably would have went on their merry way. When Mrs. C refused the gown, M & C felt no sense of power or control and reacted accordingly with inappropriate behavior.
What caused that inappropriate behavior to occur?
When stimulated, our sympathetic nervous system stimulates the brain that makes a reflexive decision to take either fight or flight response. M & C made a reflexive decision to fight. Once a reflexive decision is made, a domino effect occurs and Newton's Law of Motion is in effect.
Unless an external force changes the state of a motion, the motion will remain in action. M & C had synergism in that the two were on the same course of action, which fueled the motion. If either M or C would have said something like, "You know- it's her right to refuse to wear a gown. Let's leave her alone", the external force would have changed the state of the inappropriate motion and the motion would have ceased.
In the early '90's, I learned that certain anticonvulsants were being used to help control explosive disorders. An explosive disorder contains features such as "sudden episodes of impulsive, aggressive, violent behavior or angry verbal outbursts in which (an individual) reacts grossly out of proportion to the situation".
A neurologist affirmed my belief that an explosive disorder episode is not unlike a seizure, in that neurons are stimulated causing an out of control chain reaction.
Did M & C both experienced an episode of an explosive disorder? No- but they both experienced the stimulus that caused the inappropriate behavior and both did not possess the internal governing mechanism to cause the behavior to cease.
Locking the barn after the horse is stolen and punishing the thief is tact to take in preventing a parochial future crime. However, understanding the motivation and actions behind the theft will universally assist in preventing many more like crimes.
Understanding is great. Like understanding why killers, arsonists, serial killers and mass murderers kill. We definitely need to try to understand these people and try to prevent these things from ever happening.
These 2 aides should still be flogged, drawn and quartered, tarred and feathered, and ridden out of town on a rail. Not to mention "de-certified".
People like these taunters of the elderly, helpless woman should never work again with vulnerable people - kids, adults, the disabled.
In reading this and I am thinking of my loved ones and I become upset. Honestly, I feel that termination is not enough and they should spend some time in jail and placed on a registry. This behavior was definitely criminal behavior in my opinion.
I agree they are seriously worked very hard and not paid well enough. How to fix that?
If I were the owner of a facility:
- free or low cost child care onsite for kids from a few weeks of age through preschool (up to age 5) This benefits not only parent and kids, but also the elderly, who often love to have kids around. all shifts, 7 days per week
- sick care on site for kids, while the parent is at work, for all shifts, 7 days per week, by a licensed nurse, who can give meds, check temps
- adequate staffing
- respect toward UAP's, the same being required from them
- tuition (either paid partially up front, via payroll deduction, or reimbursed for a B or better in a class that helps them work toward LPN, LVN, RN, maybe Med Records or other cert or degree that would benefit not only my facility but the worker, too
- free bus passes or car allowance
- transportation that goes to actually pick up the worker and kids who will be in child care or sick child care, and that actually takes them home again
- premium pay for weekends, holidays, overtime
- free meal every shift
- plenty of lifts, gloves, linens, etc. and various assistive devices that work and are available
- free uniform and shoes every year and upon hire, or cash in lieu of these
- quarterly recognition of worker birthdays via a party to which they can bring their kids or a different guest; goal is recognize their BD and help them have family time over a nice meal and fun event
- cash or gift card to buy groceries at Christmas, Thanksgiving, maybe another couple of holidays at other times of the year
- monetary award, at a ceremony, for being chosen "worker of the quarter" or some similar achievement; chosen by the nurses anonymously; gala affair with food and recipient's family invited;
- party for workers' kids on premises - petting zoo, food, balloons, crafts, face-painting, wading pool, etc. during Summer vacation; residents are also invited, of course; fun for all
Probably cost a small fortune, but likely worth it to get and keep the best workers.
I would include other low-paid staff in these things - laundry, kitchen, housekeeping, etc.
What would I do for nurses? Fire UAP's who sass them and refuse to follow legitimate orders. Oops, I said the "O" word! Yes, I do believe nurses are/should be actually in charge.
Nurses can get in on transportation and child care, holiday gifts, uniforms, tuition.
I'm thinking about letting each worker do a load of personal laundry each week, at work, for free. Have to monitor closely to prevent abuse.
Sigh. Dream on...
Where can I submit my application? This place sounds perfect...
Long term care is a woefully under represented issue in the United States.
On average, each facility is reimbursed just over $200 per person per day...which initially sounds like a lot right?
Average hotel rate per day in the United States is $133 and the gross profit margin is about 30% so lets figure it costs an average of around $93 per day to run a hospitality organization.
Lets say for a wing of 30 residents they have 1 nurse who makes $25/hr and 1 CNA who makes $12/hr with 24/hr coverage. The organization has to pay about 1.3 times the hourly rate given taxes and benefits and such so the facility is paying $32.50/hr and $15.60/hr respectively for a total of $1,154.40 for 24hr coverage for 1 nurse and 1 CNA. Average that over the 30 patients and it is $38.48 per patient per day. Throwing in other miscellaneous staff such as billers, secretaries, admins, etc and you are probably looking at close to $50 in payroll per patient per day.
If you figure in normal non-specialized food it may cost on average about $12.93 in groceries for 3 meals with no snacks. Lets round that up to $15 a day to include some snacks and beverages. Keep in mind I am not counting in the cost of cooking which is much higher than home due to the cost of commercial cooking and the regulatory requirements but $15 might be fair.
When you account for just the hospitality ($93/day), clinical staffing ($50/day), and the cost of groceries ($15/day) you are looking at $158 to house a single LTC patient. This of course does not factor in the all of the other expenses that might occur such as something as simple as entertainment.
As a country we pay for the bare minimum treatment of our elders. Personally I wish we would do more to encourage home care. Maybe reimburse family members that $200day which would help to offset having home care (16 hours of CNA coverage at $15/hr = $240/day) along with tax incentives.
Forest2
625 Posts
You are right on here. I have worked with many fine aides in LTC however, there are some that were not as mature, have the self control or make good decisions as others.