By Melinda Young, Author

Resident-to-resident violence between patients with dementia in long-term care home settings can turn deadly.

In one such case, a Korean War veteran and former investigative journalist in Charlotte, NC, suffered from Alzheimer’s disease. While he was a resident in long-term care facilities, he was repeatedly hit and pushed by other dementia patients, says Eilon Caspi, PhD, gerontologist and dementia behavior specialist and research associate in the school of nursing at the University of Minnesota.

The last time it happened, the patient had wandered into the wrong room. The elderly resident returned to the room, found the patient on his bed, and then beat him with a cane. The patient was left bloody, bruised, and lying unconscious on the floor, and died a week later. Pneumonia was the official cause of death listed in the autopsy report.1

When the nursing home staff called the patient’s wife to let her know he was injured, they said he had fallen. For days, she didn’t know of the beating.1

The long-term care (LTC) staff that initially called the patient’s wife said she didn’t need to rush to his bedside, that the patient was fine. “She walks in on Monday and was shocked to see his injuries, and they kept telling her he just fell,” Caspi says.

“She said those injuries could not have happened due to a fall, so they brought in someone in charge and another staff member and told her that he had been beaten on Thursday, and they sent him to the ER, but he had no broken bones,” he explains. “There was no apology, no explanation, and that’s what she had to deal with — it was traumatic for him and devastating for her.”

The patient’s wife was interviewed by a filmmaker who is working on a documentary about what happened to the patient, with the goal of raising awareness of the problem, Caspi says.

Aggression among dementia patients is not uncommon, and LTC facilities should have adequate staff on hand to prevent it from occurring. But as Caspi has found in his research, LTCs often are inadequately staffed, which can lead to abuse, violence, and deaths.

“I’ve been focusing on this phenomenon for over a decade,” Caspi says. “It is prevalent and nothing new to nursing aides, nurses, and social workers, but there are very strong disincentives to report internally and externally.”

LTC facilities worry about bad publicity and their ability to market themselves as safe homes. Reports of the violence and deaths also could affect their federal funding, and they’re concerned about liability, he says.

Resident-to-resident aggression is highly prevalent, according to a study that found 20% of residents of 10 New York nursing homes had experienced at least one incident over a one-month period.2

And the incidents go unreported. There are no deficiency citations related to this type of aggression and abuse. The CDC does not consider resident-to-resident aggression a form of elder abuse, although it acknowledges that such aggression produces outcomes that are just as harmful as elder abuse.2

“If I’m an administrator of a nursing home and I report we failed to fulfill our duty to protect a vulnerable adult from a frail elder with dementia, this could be used in a court of law against us, so there is a disincentive to report that and a disincentive to report externally to law enforcement,” Caspi says. “Nurses could have these reports reflect negatively on their job performance.”

Caspi’s research suggests that most of these incidents are not reported, which is a problem that could be changed when the new federal nursing home regulations are fully implemented in 2019.2

If there was a resident-to-resident aggression CMS F-Tag citation or state survey deficiency citation that is unique for investigating these incidents, then the public would have more accurate safety information about LTC homes, and some of this violence could be prevented, Caspi says.

“When they issue a citation that falls under the broad bucket of abuse, neglect, and accident, it’s buried forever in those buckets because it takes years to identify those incidents,” he explains. “It’s like finding a needle in the haystack. But with one F-Tag, I could identify all of the incidents across the nation, and we could learn from them and prevent future incidents.”

REFERENCES

1. Bartelme T. Alzheimer’s and violence. Post & Courier, May 16, 2009. Available at: http://bit.ly/2mJMcvb.

2. Caspi E. A federal survey deficiency citation is needed for resident-to-resident aggression in U.S. nursing homes. JEAN 2017;20(4):193-212.