Taking a hard line against crime.

In-house crime, most particularly theft, is a problem that plagues all health care facilities. Unfortunately, nursing homes are far from immune. The following "case studies" depict theft in the nursing home in some of its varied forms, as well as some methods used to stop the crimes, and the perpetrators, in their tracks. The "Lessons Learned" at the conclusion of each scenario give long-term care providers some concrete ideas aimed at deterring theft, as well as other crimes, in their own facilities.

Nipped in the Bud

The resident in room 102 reported that someone had stolen six postage stamps from her room while she was at breakfast. The busy nursing supervisor replaced the stamps from her own handbag, thinking the resident had lost the stamps or forgotten that she had used them. The supervisor neither looked for the stamps nor reported their disappearance to the administrator.

During the week thereafter, no thefts from residents' rooms were reported. Then, during the second week after the stamps disappeared, four incidents of petty theft were reported from rooms 100-120 during mid-day hours. What was happening?

Had the nursing administrator been given the gift of omniscience, she would have known that the stamps and all the other small items were stolen by the same person -- an aide named Julie. Julie, who had begun working at the facility the previous month, was the archetype dishonest employee. By stealing the stamps, she was sending up a "trial balloon" to see what would happen. Since nothing did, Julie concluded that she could steal with impunity. A week later, she had resumed her petty theft in earnest. She also began looking for more valuable items like money and jewelry.

Finally, the administrator and the rest of the staff working on the first floor corridor were informed of the petty thefts. The next day, Julie was observed by another staff member reaching into a resident's dresser drawer and stealing a gold necklace.

Before Julie's apprehension, two other employees were waiting to see what their employer would do about these thefts, their reasoning being that if another employee could steal and get away with it, so could they. After all, if their employer didn't care, why shouldn't they "join in the fun"? Julie's demise made them change their minds. They decided that stealing wasn't worth the risk. Had Julie not been caught, this nursing home might have ended up with three thieves rather than none and a serious mini-epidemic of crime on its hands.

Lessons Learned: 1. Investigate every theft promptly. 2. Make employees aware of theft occurrences; sometimes they can help solve the problem. 3. Theft will escalate and others may joint in if nothing is done.

"Oh, I Found It!"

When Mrs. Brown's diamond engagement ring was stolen from her room, she threatened to call the mayor, the FBI and the President of the United States unless it was returned within M hours. The administrator, Agnes King, reviewed her theft report file and found that no thefts had been reported in Mrs. Brown's section of the building during the past six months. She had every square inch of Mrs. Brown's room searched, in the process, moving every piece of furniture in the room. She checked work schedules and found six employees who had had access to Mrs. Brown's room during the time the ring disappeared. She interviewed these employees and learned nothing. All six convincingly denied stealing the missing ring or knowing who might have stolen it.

Mrs. King remembered a colleague who had had a similar problem and solved it by using some kind of employee questionnaire. The questionnaire was aimed at defining employees' conceptions of honesty, and included questions pertaining to situations similar to the missing ring incident. She administered it to each of her six suspects and returned the completed questionnaires to the publisher for analysis. The results startled her. The analysis pinpointed a trusted custodian as the probable perpetrator.

Gene, an employee of six years, had vacuumed Mrs. Brown's room that day. Before questioning Gene about this, Mrs. King decided that she and the custodial supervisor should check the contents of Gene's vacuum cleaner bag. They did so without telling Gene. The ring wasn't in the bag.

Mrs. King summoned Gene for an interview, during which he seemed nervous and wondered why he was being questioned again. He was told that some of the answers in his questionnaire didn't look too good. When he learned that Mrs. Brown was so upset that she wanted to "contact the President," he asked if someone would lose their job if the ring was not found.

Mrs. King didn't answer directly but asked Gene if he had emptied his vacuum cleaner bag during the past four days. He said, "No -- not since last week." She suggested that the ring might have fallen on the floor and that Gene might have unknowingly vacuumed it up. A look of relief spread across Gene's face as he said, "Gee, I don't know. I'll go look in my vacuum cleaner right now!" Ten minutes later, Gene returned with the ring in hand. "I found it in the vacuum cleaner bag, just like you thought!" His smile froze when Mrs. King responded simply, "Gene, you're fired."

Lessons Learned: 1. Maintain a theft report file. 2. Colleagues in other facilities may be able to advise you on difficult theft situations. 3. Sometimes new approaches like a theft investigation questionnaire can help. 4. Use your imagination to bluff or trap the perpetrator.

Zero Tolerance 

Thelma Crabtree is the executive director of The Crabtree Nursing Home. Believing that an ounce of prevention is worth a ton of cure, she conducts part of every new employee orientation class herself. She reviews the Employee Manual with all the new employees with particular emphasis on her home's "Zero Theft Tolerance Policy."

Part of her presentation goes like this: "When I first started in this business 30 years ago, I caught one of my dietary aides stealing food out of the kitchen. I asked her, 'Why are you stealing food?' Her answer was, 'Nobody ever told me I shouldn't!'

"Not only am I going to tell you that you shouldn't steal, but I'm also going to tell you what will happen if you do. We will use every means at our disposal to catch anyone who steals anything from this building or the people who live here. In the past, we've used hidden cameras. We've used undercover investigators posing as regular employees. We've used lie detector tests. When we've caught employees stealing, we've not only fired them, but we've had them arrested and put in jail.

"The sheriff of this county is a personal friend of mine and he doesn't like to come up here. But he'll come up here in a heartbeat if I ask him to. This nursing home takes good care of its employees as well as its residents, and we'll take care of you, too -- if you've got a problem, come and see me. But don't ever steal from this building."

After Mrs. Crabtree finishes her presentation and leaves the room, the training officer takes over. To reinforce what her boss has said, the training officer tells this story: "Five years ago, Mrs. Crabtree had an assistant director whom she was training to be her successor. She treated that woman like a sister.

"The assistant used to carry this big handbag. One night she and Mrs. Crabtree were leaving to go home. Their cars were parked side-by-side in the parking lot. As the assistant bent down to open her door, a roll of toilet paper spilled out of her handbag and began rolling across the parking lot, unwinding as it rolled. The parking lot was full of day-shift employees getting in their cars to go home. All of them stopped and watched that toilet paper unroll.

"Mrs. Crabtree just looked at her assistant, who said, 'We were out of toilet paper at home and I knew I wouldn't have time to stop,' to which Mrs. Crabtree responded, 'You'll have plenty of time to stop now. You don't work here anymore.'"

Lessons Learned: 1. Develop a zero theft tolerance policy and let your employees know about it. 2. Anti-theft messages during orientation can reduce employee theft dramatically. 3. Make clear that any employee caught stealing will be fired, regardless of their position or the value of what they steal. 4. Convincing people they will be caught and dealt with if they steal is a powerful deterrent.

A Break in the Routine

Paul Trask was a highly efficient administrator. He always stuck to the same schedule, arriving to work at 9:00 a.m. and leaving at 6:00 p.m. His employees could set their watches by his comings and goings -- until one night.

Trask had a speech to write and decided to stay after hours until he completed it. He closed his office door and started writing. It was summer and the days were long so he had no need to switch on his office light.

He'd been working for about an hour when he heard the outer office door open. Someone had come into his secretary's office. One of the lights on his phone suddenly lit up. He wondered what was going on so he pushed the button on his speaker phone to listen in. Here is what he heard:

"Yeah, hey look. I got some more greenies... and some reds... and some percs. I'll give you the percs for ten each. My shift ends at midnight. Meet me by my car and we'll do the deal."

Trask was stunned. One of his nursing assistants was stealing medication and selling it. He waited until the caller hung up and then he hung up quickly.

At midnight, the nursing assistant strolled out of the facility and walked toward the parking lot. As he approached his car, he saw that his buyer had already arrived with money in hand. So had someone else. From the woods surrounding the parking lot came the wide beams of spotlights and the sound of a bullhorn, "This is the police. You are under arrest. Raise your hands and put them the top of the car." The police found the pills in the nursing assistant's pocket.

Trask now makes irregular, unannounced visits to the nursing home during his off-hours. He varies his schedule so much that he might show up any place in the building at any hour. His employees never know for sure.

Lessons Learned: 1. Vary your schedule and routine. 2. Make unexpected visits at unexpected times in unexpected places. 3. Be nosey, be curious, and investigate unusual situations.

Clues From the Exit

Interview

Sally Magruder, the administrator of the Magruder Home, interviews every departing employee. One day she was interviewing Lenore who was being terminated for absenteeism. Her final question to Lenore was, "Can you think of anything we could do that might make things better for the employees or the residents of this home?" Lenore's response was, "Yeah. You can get rid of Tommy Marsh, that new guy who works in the laundry." When asked why, Lenore told Mrs. Magruder that Tommy "likes to break into houses, steal stuff and beat up women. He beat up his own mother but she didn't press charges."

Magruder wanted to know how Lenore had learned all this. She said, "My brother told me about him and to stay away from him." Magruder confirmed the information Lenore had offered with others who knew Tommy. Tommy Marsh is no longer employed at the Magruder Home (and, of course, should never have been hired in the first place).

Lessons Learned: 1. Brief exit interviews can yield useful information. 2. When one employee accuses another, look for corroboration. 3. Employees with histories of assault are dangerous and should never be employed in nursing homes.

Conclusions

Employee theft is just one of many personnel problems that are easier to prevent than to solve. Prevention should begin before an applicant becomes an employee. To this end, it's a good idea to try different approaches to pre-employment screening and to combine the methods that work best for you.

Some nursing homes use background checks to help screen their applicants, the cornerstone of which is the criminal records check. While a criminal records check will tell you whether or not an applicant has been convicted of a criminal offense in a particular jurisdiction, these checks have their limitations. For example, most people who steal from their employers are never caught. Of those who do get caught, even fewer are prosecuted, and of those caught and prosecuted, some are never convicted. In other words, there are many dishonest people looking for work who have no criminal convictions for theft.

The same limitations apply in cases of assault, one of the most common forms of which is spousal assault, referred to by its euphemism, "domestic violence." A wife will seldom testify against her husband and if she doesn't testify, her assailant gets off -- no conviction, no criminal record.

Another pre-employment screening technique that can be used in addition to or in lieu of the criminal records check is the written honesty test. Once used primarily by retail businesses, there are now honesty tests designed exclusively for the nursing home to assess the likelihood that an applicant will steal from his or her employer. The tests can be scored by computer on-site, yielding results while the applicant is still on the premises.

With the employee screening and incident review modalities now available, there is really no excuse for crime to take hold in the nursing home. Combined with a hard-line attitude and a little ingenuity, they offer administrators new hope for creating secure environments.

James Bassett is president of the J.W. Bassett Co., a security consulting company in Cincinnati, OH specializing in theft investigation and pre-employment screening questionnaires and other tools. For further information, call 513-421-9604.