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Christine Mulcahy felt her disgust and revulsion turn to anger as she watched video footage of her frail 75-year-old sister being sexually assaulted by a male caregiver at her senior home in Burnsville.

The aide, John Akonkoh, 53, could be seen repeatedly and aggressively attacking her while she lay naked on her bed at the Regent at Burnsville assisted-living home.

The woman, who had dementia and was partially paralyzed from a stroke, tensed up and flinched as if in pain, according to a criminal complaint filed in Dakota County District Court.

"I cried. I was shaking. I couldn't believe what I was seeing," said Mulcahy, a registered nurse who lives in Apple Valley. "And what he was potentially doing that I didn't know about … just makes you feel ill."

The graphic video footage is now at the center of a legal case that has reignited concerns over patient safety in senior homes, while underscoring the growing role that new video surveillance technology is playing in monitoring care.

Were it not for a tiny $30 camera placed by Mulcahy in her sister's room, the violence likely would have gone unnoticed and the alleged perpetrator might still be working there, Mulcahy and her attorneys said.

Planting cameras — some as small as hockey pucks — in senior homes has grown in popularity since lawmakers four years ago changed state law to explicitly give Minnesotans the right to use cameras and other recording devices in most such facilities.

Advances in video surveillance technology have made it possible for families to monitor the care of their loved ones with remarkable precision and clarity. With devices that cost less than $50, people can now receive automatic alerts on their smartphones when someone enters a resident's room, or when there is unusual activity or sound. Relatives have placed the internet-enabled devices inside potted plants, stuffed animals and atop furniture in their loved ones' rooms.

The recordings can have a significant impact in cases where residents are too frail or too cognitively impaired to speak on their own, or when relatives suspect abuse but feel that authorities are dismissing their concerns. Allegations of maltreatment in senior homes are notoriously difficult to prove without witnesses, and cameras are one of the few ways families can corroborate claims by elderly relatives, senior advocates say.

Earlier this year, a staff member at a Duluth assisted-living facility was caught on camera stealing a supply of morphine from a resident with dementia who lived in the memory care unit, a state investigation found. In 2016, an aide at a Hopkins senior home was arrested and charged with two counts of assault after video from a hidden camera showed her repeatedly striking an elderly patient on the head.

"Cameras are a powerful, powerful tool that we all need to better understand," said Kristine Sundberg, executive director of Elder Voice Advocates, a group that advocates for quality care for older adults and people with disabilities. "We've seen too many cases in which our vulnerable elders have not been believed because they didn't have a witness in the room or video evidence."

The Minnesota Department of Health annually receives nearly 20,000 reports of maltreatment at state-licensed care facilities, though only a fraction of the reports lead to substantiated findings of maltreatment. Even with recent improvements at the agency, investigations can last months without a resolution. In 2021, the department's Office of Health Facility Complaints substantiated maltreatment in 43% of completed investigations.

Video evidence critical

Yet with Mulcahy's video, reaction was swift. The aide, Akonkoh, was taken into custody within hours after Burnsville police were shown the footage.

Akonkoh was charged with two counts of first-degree criminal sexual conduct, and the state intends to seek an aggravated sentence due to the victim's partial paralysis, dementia and mental health diagnoses, according to the complaint filed in late December. He has pleaded not guilty to both charges.

Akonkoh had been working at the Burnsville facility for seven years.

Mulcahy arrived at the senior facility in Burnsville with the police and watched as officers escorted her sister's alleged assailant out of the building in handcuffs. Last month, she also filed a lawsuit against the Regent at Burnsville facility and three of its related entities, accusing them of failing to properly supervise staffers.

"I just broke down in tears," Mulcahy said of watching Akonkoh's arrest. "Actually seeing that, I can't describe the weight that came off my shoulders."

A spokesman for Cassia, an Edina-based company that owns Regent at Burnsville, declined an interview request. In a statement, company officials said that Akonkoh has been terminated and that they have reviewed safety procedures and retrained staff members.

"We are heartbroken about this report and our hearts go out to our resident and the family," the company statement said.

Mulcahy said she wrestles with guilt that she didn't install the camera sooner. She only got the idea after her sister was hospitalized last fall with an unexplained injury to her ribs, and there were conflicting reports on the cause.

On Christmas Day, Mulcahy placed a tiny camera atop a cabinet in her sister's room after notifying the facility. Less than 48 hours later, she said, the horrifying footage appeared on her smartphone.

"The camera was of huge importance," said Joel Smith, an attorney with the Kosieradzki Smith Law Firm in Plymouth representing Mulcahy. "Without the video evidence, the wrongdoing likely never would have come to light."

A nurse performed a sexual assault examination of the victim and identified injuries to her vagina. The victim has not been identified in court papers and the family declined to disclose her name, citing privacy concerns.

"People who take advantage of children and elderly people, especially people with dementia … I think are at the bottom of the mud pit," Mulcahy said.

Cheryl Hennen, the state's ombudsman for long-term care — Minnesota's official advocate for seniors — said the incident highlights the need for more public education about the use of cameras in senior care communities. Her office receives more than 60 inquiries a month from Minnesotans seeking information on surveillance technology.

The right to use such devices is now clearly enshrined in state law, though with some rules to protect resident privacy; for instance, families must notify the facility and obtain consent from residents being monitored.

"This is a right that people have and they shouldn't be reluctant to use," Hennen said. "Just imagine, had that camera not been in that resident's room, how long that horrific behavior would have continued."