The Conversation reported on the epidemic of resident to resident assaults in nursing homes.  Many preventable deaths in nursing homes are a result of aggression between residents. This most commonly occurs in people with dementia, their research has found.  Published in the Journal of the American Geriatrics Society, they examined records for all resident-to-resident aggression-related deaths among nursing home residents reported to a coroner in Australia between 2000 and 2013.

Their study examined the frequency and nature of resident-to-resident aggression resulting in the most severe outcome – death. In their analysis, almost 90% of residents involved in resident-to-resident aggression had a diagnosis of dementia. Three-quarters had a history of behavioral problems, including wandering and verbal and physical aggression, which are common symptoms of dementia.

The rising global prevalence of dementia, particularly in the nursing home population, means aggressive behaviors between residents will increasingly be an issue. Two high-level reports on elder abuse in aged care in Australia have recommended better reporting systems so we can understand and prevent all such deaths in nursing homes.

Resident-to-resident aggression is an umbrella term that includes physical, verbal or sexual interactions that are considered to be negative, aggressive or intrusive. These behaviors can cause serious physical harm or psychological distress.

The prevalence of aggression between nursing home residents is difficult to determine. Recent research estimates at least 20% of nursing home residents in the US were involved in such incidents.

Most incidents appeared to be unprovoked, or were triggered by communication issues or a perceived invasion of personal space. Importantly, only one of the 18 studies reported a single death as the result of physical resident-to-resident aggression.

Our research found most exhibitors of aggression (85.7%) were male. The risk of death from aggression between residents was twice as high for male as for female residents. Those who exhibited aggression towards other residents were often younger and more recently admitted to the nursing home than their targets.

Incidents commonly involved a “push and fall”. Seven (25%) related deaths resulted in a coronial inquest, but criminal charges were rarely filed.

However, this is likely to be just the tip of the iceberg as there is much potential for underreporting and misclassification of resident-to-resident aggression deaths. We have limited data on how often incidents of aggression between residents in Australia occur but do not result in death.

Fox 8 reported that police are investigating a suspicious death at Concord Care and Rehabilitation Center in Ohio after a confrontation between two nursing home residents.  Police Detective Joe Rotuno said Richard Cain, 65, was found unresponsive in his room at Concord  around 7 p.m. Thursday.  Rotuno said Cain’s roommate, who is 63 and usually in a wheelchair, told staff Cain was lying on the ground, and he believed he was dead. Staff then found Cain clutching a chunk of his roommate’s hair and called police, according to investigators.

The roommate told officers that the pair had argued over whether to close the room door when Cain began choking the roommate, according to Rotuno. He said the roommate reported he then punched Cain in the stomach, causing him to fall backward and hit his head.

Rotuno said both roommates suffered from mental health and other issues, and that staff reported the roommate had a history of anger issues. He said they had gotten into arguments in recent weeks.  “We’ve heard there’s been a lot of verbal altercations between the two,” Rotuno said. “Our suspect does have a history of being what we would call ‘angry’ at the facility, having issues with other residents, having issues with other staff.”

“If his roommate had to defend himself, I don’t blame him at all. I blame the nursing home and staff for not paying attention,” said Bonnie Cain. “They’ve been in several verbal confrontations weeks prior and nobody’s done anything about it. Why couldn’t you separate them?”

She said she wants justice and more training for nursing home staff.

“Every time I close my eyes I see my dad, and it’s just so heartbreaking,” Cain said. “Why couldn’t something be done? Maybe my daddy would still be with me today.”

 

 

National Geographic published Maja Daniels’ series “Into Oblivion,” a documentary project that exposed some of the many issues surrounding Alzheimer’s patients while also highlighting society’s generational disconnect from its elders. Shot over the course of a three-year period, “Into Oblivion” was the inaugural winner of the Bob and Diane Fund, a photographic grant that supports visual storytelling about Alzheimer’s and dementia.  The Bob and Diane Fund was started by National Geographic Creative employee Gina Martin in honor of Martin’s mother, Diane, who died from Alzheimer’s in 2011, and her father, Bob. The winning photographer receives a $5,000 grant to support his or her work.

While on a tour of a geriatric hospital in France, photographer Maja Daniels came across a locked door with portholes in it. Behind it, someone was trying to get her attention. When she asked, Daniels learned that the door led to a protective unit for the hospital’s Alzheimer’s patients, meant to keep them safe and to keep  them from wandering off and getting lost.

“I was just struck by the image of that door,” says Daniels.

When Daniels showed the staff her photos, they were shocked by the images of people by the door.

“Sometimes the hardest things to see are the things that are closest to us,” Daniels says.

Shortly after, they covered the door with wallpaper to make it blend in and defer patients away from it.

“Even those smaller changes are really important,” Daniels says.

 

 

Detroit News reported that two nursing home caregivers pled guilty to intentionally placing false information on a chart involving medical records. Denise Filcek and Yahira Zamora were charged in the death of an 85-year-old woman who was found in cold weather outside an assisted living center.  A resident with dementia, Kathryn Brackett, wandered outside and was found dead on Oct. 27, 2016.

Filcek was responsible for making bed checks. She told the judge, however, she didn’t check on everyone. Sentencing is Nov. 28.

Zamora pleaded no contest to second-degree vulnerable adult abuse. Authorities say she reset a door alarm without determining whether anyone was outside Crystal Springs Assisted Living Center. She’s also awaiting sentencing.

York Daily Record reported that Woodland Terrace lost its license to operate a nursing home after finding “gross incompetence” following the death of a patient who wandered away from the home.  Audrey Penn’s body was found in a roadside ditch nearly a month after she was reported missing from Woodland Terrace at the Oaks nursing home.

The agency said that on the morning of Penn’s Aug. 23 disappearance, a staffer noticed she wasn’t in her room but violated policy by waiting 90 minutes to alert a supervisor and start a search.  Penn had a history of trying to leave the home’s secure dementia unit. Earlier this year, the report said, she used a keypad to unlock a door and went to a staff break area. At other times, she was seen pushing on doors in the dementia unit and pressing buttons on the keypad.

 The agency said Woodland Terrace failed to “adequately address the resident’s exit-seeking behaviors,” calling her a “victim of neglect.”

The Atlanta Journal Constitution reported the tragic and preventable death of nursing home resident Dorothy Broome.  Police were dispatched to the area about 10 p.m. Aug. 25 after a man saw the woman’s wheelchair in the ditch on his way home from work.  Broome was found face down along South Main Street.

Broome was a wheelchair dependent resident at Gilmer Nursing Home who was found in a nearby ditch and later died after she fell while leaving the facility after a fire alarm was pulled, unlocking the doors.  Earlier that night, a fire alarm was pulled and Broome fell as she was leaving the building and sustained multiple injuries, the nursing home said in a statement to The Atlanta Journal-Constitution through its attorneys.

 

The News-Gazette reported on another tragic wrongful death caused by neglect at a nursing home.  Sonya J. Kington, a resident at Champaign County Nursing Home, was found dead in the home’s courtyard on June 6, a Saturday when the high temperature reached 87 degrees.  Kingston’s body was found in an exterior courtyard. Ms. Kington was lying in direct sunlight, her skin was “very hot to touch” and she had vomit on both sides of her mouth.

According to an investigation by the coroner’s office, video footage from inside the nursing home appeared to show Ms. Kington entering the courtyard at 1:47 p.m. It isn’t until about 5:15 p.m. that staff members are seen searching for her.  The report noted that the investigation “could not account for Ms. Kington’s whereabouts” during the more-than-three-hour period

“Staff is seen visibly shaken at 5:30 p.m. when it appears they have located Ms. Kington unresponsive in the courtyard,” says the report by Deputy Coroner Tracy Brookshire.

The report said that a nurse and certified nursing assistant on duty at the time violated the nursing home’s door alarm policy and policies for providing adequate supervision to residents in the courtyard.

The Sacramento Bee reported the voluntary closing of the Eagle Crest nursing home, formerly known as Carmichael Care & Rehabilitation Center after state inspectors determined that a female resident was sexually abused multiple times by another resident at the facility.  The facility’s failure to safeguard the woman had placed all 36 female residents in Immediate Jeopardy of, and at risk for sexual abuse, the state found.

The facility has a history of neglect and inadequate care and was on the federal government’s consumer-beware list of troubled facilities.  Eagle Crest spent more than three years on the “Special Focus Facility List” maintained by the U.S. Centers for Medicare and Medicaid Services. The list is a kind of improve-or-else warning program aimed at getting operators to correct serious problems, or lose their ability to collect government funding.  Some recent inspection reports show the facility has been written up and penalized for inadequately treating or preventing bed sores, failing to self-report possible abuse and not attempting CPR on a resident who wished to be resuscitated.

The California Department of Public Health show that the state recommended this summer that federal regulators drop the facility from its Medicare provider rolls, a drastic action that strips a nursing home of its critical government funding.

In a business move that will upend the daily lives of dozens of patients and their families, Pennsylvania-based Genesis HealthCare Inc. recently notified the state it would voluntarily close Eagle Crest in October.  In June, the U.S. Department of Justice announced that Genesis HealthCare Inc. would pay the government nearly $54 million to settle six federal lawsuits. The government alleged that companies and facilities acquired by Genesis had submitted false claims to government health care programs for medically unnecessary services, and “grossly substandard nursing care.”

DHEC officials confirmed the agency is currently taking enforcement action against Brookdale Senior Living Facility in Charleston, where a resident died in July 2016 after wandering away and being killed by an alligator.

The action comes as a result of violations cited during a series of recent inspections and investigations, according to DHEC’s spokesman Robert Yannity.

According to DHEC’s website, when an agency takes enforcement action against a facility, administrative staff are called to attend a conference with DHEC officials to go over the violations and discuss corrective actions.

If DHEC and the violating facility come to terms, a mutually agreed upon “Consent Order” is issued outlining the actions which must be taken, and DHEC’s expectations.

 

The St. Louis Post Dispatch reported the lawsuit filed after a resident was left in a tub for over 8 hours causing her wrongful death.  Steven Moreland alleges in the lawsuit that Lois Moreland’s March 2016 death was the result of negligence by the St. Sophia Health & Rehabilitation Center.

The lawsuit accuses St. Sophia of putting profits above health care by deliberately understaffing its 240-bed nursing home.

“When there are not enough staff members to care for residents, it creates an environment where employees are trying to do too many things that they forget about putting a resident in a bathtub and end up leaving her there for over eight hours,” Steven Moreland’s attorney, David Terry, told the newspaper.

Terry added that Lois Moreland was “unable to comprehend her circumstances or fend for herself because there were not enough employees to meet the needs of each resident. And as a result, Lois Moreland paid the price.”

 After Moreland’s death, government inspectors determined that St. Sophia residents were in immediate jeopardy — the most severe status given to nursing homes. St. Sophia was fined $39,260 and required to file a “plan of correction.”