Connecticut Long Term Care Ombudsman Program

Voices Speak Out Against Retaliation

Voices Speak Out Against Retaliation

History and Background

The Fear of Retaliation project began after a resident raised a concern at the 2006 VOICES Forum, a statewide event where Resident Council Presidents, legislators, and public officials discuss issues most important to people living in Connecticut’s long-term care communities.

In response, the Connecticut Long-Term Care Ombudsman Program (LTCOP) formed a Fear of Retaliation Workgroup and partnered with the University of Connecticut Center on Aging to study the issue. The 2007 survey asked 150 residents across nursing homes, assisted living, and residential care homes whether they feared retaliation for voicing concerns. Nearly one-fourth of nursing home residents said they did. Others reported hesitating to complain because they didn’t want to “get anyone in trouble.”

Interviews revealed that retaliation can range from blatant acts to subtle, hard-to-detect behaviors—and that the fear itself can cause as much distress as actual events. These findings led LTCOP to create the first training video, “Voices Speak Out Against Retaliation,” to raise awareness and promote open dialogue about residents’ rights and protections.

Breaking the Silence: Updated 2025 Video and Training Guide

In 2025, the Connecticut Long Term Care Ombudsman Program, in partnership with the Colorado State Long Term Care Ombudsman Program, released an updated training resource, Breaking the Silence: The Fear of Retaliation, consisting of both a video and companion training guide.

Developed with Dr. Eilon Caspi of Dementia Behavior Consulting LLC, this resource draws on his expertise in research and advocacy related to resident safety, fear of retaliation, and quality of life in long term care.

The updated training expands the conversation beyond nursing homes to include assisted living communities, residential care homes, and individuals receiving long term services and supports in the community. Designed for staff, residents, families, and advocates, the video introduces key concepts and encourages a culture of trust, respect, and open communication where individuals feel safe speaking up. The companion guide builds on those themes by offering a more comprehensive educational resource to support deeper learning and discussion. 

Breaking the Silence: The Fear of Retaliation – A Comprehensive Educational Training Program Addressing Concerns and Promoting a Safe Environment When Receiving Long-Term Services and Supports. (PDF)

 


Original Training: Voices Speak Out Against Retaliation

Prompted by that initial VOICES Forum discussion, LTCOP commissioned a statewide study confirming that fear of retaliation is a real concern in supportive housing. The resulting training video helps participants recognize and respond to this issue.

A facilitated discussion following the video is recommended, asking:

  1. What did residents in the video tell you about fear of retaliation?
  2. What can you do in your role to diminish or overcome that fear?
Watch the Original VOICES Speak Out Against Retaliation on Youtube

 

Additional Resources and Reports

 

Caspi, Eilon, PhD. (June 2023).
"They Make You Pay: How Fear of Retaliation Silences Residents in America's Nursing Homes."
Prepared for the Long Term Care Community Coalition.

This report examines the pervasive issue of fear of retaliation among nursing home residents, detailing strategies and barriers faced by Ombudsman representatives.

Key Findings:

  • Prevalence: Fear of retaliation is widespread and significantly hinders the reporting of care concerns or mistreatment.

  • Barriers: Institutional culture, staffing challenges, and inadequate oversight compound the issue.

  • Recommendations: Emphasis on educational initiatives, advocacy, and legislative reforms to promote safety and dignity for residents.

The report underscores the importance of systemic changes to alleviate residents’ fears and enhance the effectiveness of advocacy programs.

For more information and additional resources, visit the LTCCC's website: LTCCC - Fear of Retaliation

Caspi, Eilon, PhD. (May 2024).
"Residents' Fear of Retaliation in America's Nursing Homes: An Exploratory Study."
Published in the Journal of Applied Gerontology.

This exploratory study provides an in-depth analysis of residents' fear of staff retaliation in U.S. nursing homes. Utilizing 100 standard survey and complaint investigation reports from state survey agencies across 30 states, the study examines:

  • Aspects of Retaliation: The research categorizes experiences into fear of retaliation, allegations of threats, perceived retaliation, and confirmed retaliation.

  • Emotional Consequences: Residents experienced heightened anxiety, helplessness, and emotional distress due to fear of retaliation.

  • Barriers to Reporting: The study highlights how fear of retaliation serves as a significant barrier, preventing residents from reporting substandard care, abuse, and neglect.

The findings call for increased awareness, policy changes, and the implementation of protective measures to ensure residents can voice concerns without fear.


Caspi, Eilon, PhD. (December 1, 2024).
"A Bridge Over Scary Water: Ombudsman Program Strategies and Barriers in Addressing Residents’ Fear of Retaliation in Long-Term Care Homes."
Prepared for the Connecticut Long-Term Care Ombudsman Program.

This report examines the pervasive issue of fear of retaliation among nursing home residents, detailing strategies and barriers faced by Ombudsman representatives. Key findings highlight:

  • Prevalence: Fear of retaliation is widespread and significantly hinders reporting of care concerns or mistreatment.
  • Barriers: Institutional culture, staffing challenges, and inadequate oversight compound the issue.
  • Recommendations: Emphasis on educational initiatives, advocacy, and legislative reforms to promote safety and dignity for residents.

The report underscores the importance of systemic changes to alleviate residents’ fears and enhance the effectiveness of advocacy programs.

 

Caspi, Eilon, PhD. (November 28, 2024).
"Silenced: Residents’ Fear of Retaliation in 40 Nursing Homes in Illinois."
Prepared for the Alliance for Community Services.

This report investigates fear of retaliation in Illinois nursing homes, summarizing 42 state investigation reports. Key insights include:

  • Case Studies: Illustrative examples of verbal, emotional, and physical abuse linked to retaliation.
  • Systemic Failures: Weak enforcement of abuse prevention policies and environments that silence residents.
  • Call to Action: Advocates for policy reforms and improved abuse prevention measures to protect residents’ rights.

Through real-life cases, this report highlights the urgent need for regulatory and cultural reforms to ensure residents’ safety and well-being in long-term care facilities.