Eric Linn made a modest request to the nursing home caring for his mother as she died of Alzheimer’s disease in the spring of 2019. He asked that she be allowed to die peacefully and without unnecessary pain.
Yet Linn’s confidence was shattered when he learned that someone working the night shift had stolen several doses of morphine and anti-anxiety medication from his mother. No one could identify the perpetrator or care enough to investigate, he said. Shaken by the revelation, Linn moved her 65-year-old mother out of the facility the next morning and into her family’s home near St. Cloud, where she died four days later.
“I couldn’t bear the thought of my mother dying this way – alone and in pain,” said Linn, a plumber. “What little she had – her sense of peace – was stolen from her.”
In the middle of a spiral opioid abuse epidemic, Minnesota’s retirement homes have become attractive targets for drug addicts and drug dealers. New research shows that nursing homes and assisted living facilities across the state often fail to protect the elderly from the theft of highly addictive painkillers – with thousands of pills being stolen each year by people charged with caring for vulnerable residents. The consequences are devastating: many older people have suffered needlessly for long periods of time without knowing the cause of their misery.
Over the past eight years, more than 11,300 drugs, mostly narcotics for pain treatment, have been stolen from at least 368 residents of nursing homes and assisted living facilities across Minnesota, according to a study that will be soon to be published. In some cases, oversight is so lax that thefts go unnoticed for months, resulting in a dozen or more casualties at a single site. On average, the thefts occurred over 56 days with more than 30 doses stolen per resident, according to analysis of 107 substantiated drug diversion reports investigated by the Minnesota Department of Health.
The authors, nearly half of whom are nurses, sometimes used ingenious methods, the researchers found. They came out of the residents’ rooms with potent narcotics hidden in their pockets, belts, bras and socks. They sometimes replaced them with over-the-counter drugs like aspirin. They diluted liquid medicine into syringes and shaved pills – keeping some of the medicine for themselves. And they carefully covered their tracks by resealing the perforated medicine packages, forging staff signatures on the number of medicines and stuffing the pill packages into shredders, the researchers found.
Some workers even ingested the stolen drugs during their shifts, jeopardizing patient care, the researchers found.
“The situation is out of control,” said Eilon Caspi, a gerontologist and professor at the University of Connecticut, who led the research project with researchers from Purdue University.
Although not new, the problem of opioid theft from seniors’ facilities has been exacerbated by the worsening opioid epidemic and a state workforce crisis that hampered efforts to combat thefts. The state’s long-term care groups say the overdue investigations prevent them from identifying the perpetrators quickly enough. It can take six months to a year for the Minnesota Board of Nursing to complete an investigation after a theft is reported. Meanwhile, a nurse may hop from nursing home to nursing home, stealing drugs from each location without providers knowing they pose a risk to patients.
Thieves have also become increasingly brazen, long-term care administrators say, exploiting their access to painkillers by stealing hundreds of pills for months at a time. In a 2018 case, a nurse from an assisted living facility in Grand Rapids stole more than 1,900 pills over a two-year period by regularly placing them in an “overflow storage area” in her office. When the facility ran out of drugs, the nurse made up excuses as to why she couldn’t access them. A total of 13 residents went without their painkillers, according to a state investigation.
“Our concern is that it’s not just drug addicts stealing for themselves,” said Patti Cullen, president and CEO of Care Providers of Minnesota, an industry group. “We see cases where the amount of drugs stolen far exceeds what a single person could use.”
But the public may find it difficult to learn about these crimes and where they occur. Indeed, state investigations of drug thefts from long-term care homes fall under the broad category of “financial abuse,” along with thefts of personal items like jewelry. Even in cases where narcotics have been found stolen, the term “theft” often does not appear in state abuse reports. Instead, regulators call it “drug diversion” — a term that some patient care advocates say understates crimes.
“We need to stop sanitizing this cruelty by calling it drug hijacking and that’s what it is – the criminal theft of painkillers,” said Kristine Sundberg, executive director of Elder Voice Family Advocates.
Recognized for years as a workplace hazard in seniors’ residences, drug thefts have resulted in a series of security protocols. Each dose of a controlled substance that is administered must be documented and medication counts are taken on each shift to detect discrepancies. Medications at high risk of theft should be stored in double-locked containers accessible only to authorized personnel, according to long-term care groups.
Aware that more changes were neededthe Department of Health and state long-term care industry groups came together in 2019 and developed a long list of recommended preventive measures measures, including stricter hiring practices and immediate reporting of suspected thieves to professional licensing boards.
Still, law enforcement officials say investigating such thefts poses unique challenges, due to the large volume of drugs administered and the number of rotating employees who have access to them. In one case this spring, more than 240 narcotic tablets for three residents went missing for several months from the Sanctuary, an assisted living facility in West St. Paul. State health investigators were unable to identify the perpetrator due to the facility’s poor record-keeping and lack of procedural oversight, according to a state report.
A spokeswoman for the Sanctuary said the facility has re-educated staff on drug administration and changed its procedures to require two staff members to sign off on all narcotics. After an internal investigation, she said, the facility fired an outside nurse believed to be responsible for the theft.
“The biggest problem is that too many people have access to these narcotics at one time,” said Brian Sturgeon, chief of the West St. Paul Police Department and former narcotics investigator. “It doesn’t just help inventory [of drugs] often isn’t done right – if it’s done at all.”
Once drug robberies are discovered, family members often feel guilty and regret not seeing the warning signs.
Lois Gildea, a research nurse at the University of Minnesota, said she had no reason to suspect a nurse was stealing painkillers from her mother-in-law at an assisted living facility in Wayzata. Then one day, a caregiver hired by Gildea discovered that some of the pills from her dispenser were a little lighter in color than the prescribed narcotic. Alarmed, Gildea placed a small camera in a teddy bear next to her mother’s bed. Video footage showed a nurse stealing narcotics while her stepmother was in the bathroom, she said.
“The most disturbing part was not knowing how long she was in discomfort and pain,” Gildea said.
Kari Shaw says her 88-year-old mother is still traumatized by what she went through three years ago.
A home nurse was discovered stealing narcotics from her mother, LaVonne Borsheim, who had a severe case of rheumatoid arthritis, and replacing them with allergy pills. The change caused such an alarming deterioration in her mother’s health that family members thought she might be dying. She slept most of the day, then woke up in agony, sometimes sobbing and begging for pain medication. No one suspected the home nurse until Borsheim’s husband took her to a pain clinic, and blood tests showed there were no opioids in her system, said Shaw.
The nurse, La Vang, hired to care for Borsheim pleaded guilty in May 2019 to stealing prescription opioids and has been condemned to 18 months in prison.
“It was a nightmare,” Shaw said. “My mum kept saying, ‘The pain is unbearable’, but no one could figure out why.”
Now Borsheim is afraid to be alone in her room in an assisted living facility in Maple Grove. She spends most of her days in the building’s lobby, playing dominoes and sharing stories, and only returns to her room at bedtime. “When someone invades your private space and almost kills you, it’s just -” Shaw said, searching for the right words. “It’s a memory that won’t go away.”
The following findings are based on a review of 107 state Department of Health investigative reports that substantiated drug thefts from Minnesota seniors’ residences between 2013 and 2021.
Number of drugs stolen: 11,328
Number of victims: 368
Average number of doses stolen per capita: 30
Average duration during which the thefts took place: 56 days
Percentage of drugs stolen from assisted living facilities: 85%
Percentage of drugs stolen from nursing homes: 15%
Sources: Eilon Caspi, University of Connecticut; Wei-Lin Xue, School of Nursing, Purdue University; Pi-Ju (Marian) Liu, School of Nursing, Purdue University