NWI.com reported that a resident of The Waters of Duneland nursing home filed a lawsuit against the facility and a fellow resident accused of attacking him last month.  Donald Barrett accuses the facility of negligence and fellow resident, Warren Riggs, of battery.  Barrett claims Riggs violently attacked him Nov. 25 and the nursing home staff knew or should have known that Riggs had a propensity for violence.

Police said at the time of the incident that Riggs woke Barrett shortly after midnight, smashed a mirror into his television and then attacked him with the removable leg holder from a wheelchair. Barrett told police he was struck several times in the face and arms. Barrett had bruising and swelling to his face, and his bed and sheets were covered with blood, police said.  A facility employee told police she had put Riggs to bed shortly before the incident and left the room believing he was asleep. She told police she went back into the room and saw Riggs with the removable leg holder attempting to hit Barrett. She yelled for help and grabbed Riggs by the arm before he could strike Barrett again.

Barrett claims in the suit the nursing home was negligent in failing to take adequate precautions, failing to maintain a proper staff-to-resident ratio, failing to implement and/or follow proper procedures, and failing to properly supervise its residents.

 

The Atlantic had a fascinating article on a Dutch “village” for residents suffering from dementia.  Van Amerongen was working as a staff member at a traditional Dutch nursing home when she became committed to making nursing homes more livable and less of a departure from reality for their residents. She envisioned a setup as far away as possible from the nondescript buildings and polished floors of her workplace, where everything carried the scent of a dentist’s medical cabinet. Over the next 20 years, she worked to secure the funding she’d need to make the idea a reality.

Today, the isolated village of Hogewey lies on the outskirts of Amsterdam in the small town of Wheesp. Dubbed “Dementia Village” by CNN, Hogewey is a cutting-edge elderly-care facility—roughly the size of 10 football fields—where residents are given the chance to live seemingly normal lives. With only 152 inhabitants, it’s run like a more benevolent version of The Truman Show, if The Truman Show were about dementia and Alzheimer’s patients. Like most small villages, it has its own town square, theater, garden, and post office. Unlike typical villages, however, this one has cameras monitoring residents every hour of every day, caretakers posing in street clothes, and only one door in and out of town, all part of a security system designed to keep the community safe. Friends and family are encouraged to visit. Some come every day. Last year, CNN reported that residents at Hogewey require fewer medications, eat better, live longer, and appear more joyful than those in standard elderly-care facilities.

Residents are only admitted if they’re categorized as having “severe cases of dementia or Alzheimer’s disease.” Vacancies are rare, given that a spot only opens when a current resident passes away, and the village has operated virtually at full capacity since it opened in 2009. Hogewey was primarily funded by the Dutch government and cost slightly more than $25 million to build. The cost of care is nearly $8,000 per month, but the Dutch government subsidizes the residents—all of whom receive private rooms—to varying degrees; the amount each family pays is based on income, but never exceeds $3,600.

To put it into perspective, a private room at a U.S. nursing home cost an average of $248 per day in 2012, or more than $90,500 annually—a figure that’s even more staggering when applied to the rapid increase in dementia patients globally. By 2030, the number of people suffering from dementia around the world is expected to hit 76 million, which some estimate will cause an 85 percent increase in dementia-related healthcare costs worldwide. By 2050, the U.S. alone will pay a projected $1.2 trillion.

Often, nursing homes are linked to poor quality of life for their residents: Issues of patient mistreatment and low levels of morale have plagued U.S. assisted-living facilities.  The act of engaging in community isn’t just about promoting better healthcare; it’s about developing a more personable and comprehensive way of treating disease. Often those with the most severe mental-health issues end up being isolated, so that less complicated cases can benefit from institutional resources. However, a study from the journal Nature Neuroscience found that isolation actually reduces the production of myelin—a fiber that maintains our nerve cells—meaning these segregating treatments may only make mental illness worse. The countless studies reinforcing how many dementia patients feel lonely or isolated, juxtaposed with Hogewey’s considerable success with these residents, call into question how much of dementia is a result of disease, and how much is a result of how we treat it.

 

In the years since Hogewey’s founding, dementia experts from the United States, United Kingdom, Ireland, Germany, Japan, Norway, Switzerland, and Australia have all flocked to the unassuming Dutch town in the hopes of finding a blueprint for handling the global problem. While dementia-only living facilities have been created outside the Netherlands, none of them have offered the amenities or level of care per patient that Hogeway provides. Last year, inspired by Hogewey, a nursing home in Fartown, England, built a 1950s village for its residents; a similar project is underway in Wiedlisbach, Switzerland.

Sometimes it truly does take a village.

A nursing home in Danbury, Conn. was fined only $1,040 by the state’s Department of Public Health after one of its residents died from choking on a meatball. The incident occurred when a licensed practical nurse left the resident’s evening meal tray at the individual’s bedside and left the room for the medication cart.  The resident was known to have swallowing problems and at risk for choking.  When the nurse returned, the resident was unresponsive. Records show that the tray was covered and that there was no visible food in the resident’s mouth, however.  The staff did not properly assess or care plan for the issue as the vulnerable resident was on a regular diet with cut up meat and thin liquids with no supervision.

The resident was taken to a hospital where the meatball was removed. The individual later died as a result of aspiration leading to hypoxic encephalopathy, which is a lack of oxygen to the brain.

The nursing home’s dietary director told state investigators that the kitchen staff was not responsible for ensuring that food was cut up for residents who have difficulty swallowing. Records show, however, that the meatballs served with the spaghetti that night were three-quarters to 1 inch in size and were considered appropriate for a soft diet.

This incident is not the only one to involve a resident choking on food, as state officials in Connecticut fined at least five nursing homes when their residents experienced similar cases. In some cases, the Department of Public Health found that negligence was to blame.  See article.

 

As a part of the Wisconsin Music and Memory Initiative, nursing homes in the state are using iPods to provide music therapy for their residents. The program, designed by the Wisconsin Department of Health Services, is geared toward residents with Alzheimer’s disease or dementia and is meant to improve their moods and their interactions with other residents, staff, and family members. As a part of the initiative, which has 100 participating nursing homes, each facility receives 15 iPods to play personalized playlists filled with music familiar to the residents.

The Hillview Health Center in La Crosse, Wis. has experienced great success by the initiative and has even bought additional iPods and set up programs through which used iPods can be donated to the nursing home for its residents. Dorothy Schwanbeck, an 87-year-old resident at Hillview participating in the program, has a playlist that contains songs by Judy Garland and from “The Sound of Music.” Her daughter, Mary Carskadon said that her mother smiles when she hears the music and is more relaxed while listening.

In addition to relaxing tense residents, the nursing home employees have also said that the therapy will be able to lessen the need for anti-psychotic and anti-anxiety medications for the residents. Residents participating in the program are also said to be more upbeat and interactive with the people around them. There are plans to expand the program to another 135 of the state’s 397 nursing homes, seeing as almost 16,000 of the 29,000 residents of the facilities have been diagnosed with Alzheimer’s disease or dementia, according to the Wisconsin Department of Health Services.  See article at Lacrosse Tribune.

 

A nursing home resident with Alzheimer’s might forget receiving poor or negligent care, but the bad feelings created by ill treatment still could persist, University of Iowa researchers say.

Investigators showed sad and happy films to 17 Alzheimer’s patients and 17 people with healthy cognition, then assessed their memories of the movies and their emotional states. Those with Alzheimer’s quickly struggled to recall details of the films, or even that they had just seen a film. However, the feelings of sadness or happiness created by the movies lasted for up to half an hour.

“Quite strikingly, the less the patients remembered about the films, the longer their sadness lasted,” the university noted in a press release. “While sadness tended to last a little longer than happiness, both emotions far outlasted the memory of the films.”

The findings show that caregivers can have a powerful impact on residents’ well-being by doing “simple” things, said lead author Edmarie Guzman-Velez, a doctoral student in clinical psychology. These things might include serving favorite foods, interacting socially or joking with patients.

Full findings appear in Cognitive and Behavioral Neurology.

The Boston Globe reported that the new standards passed by the Massachusetts Public Health Council include changes that were made to the ones proposed in 2012.  As a result of the new regulations, all nursing home employees working with special dementia care units will receive a mandated eight hours of training initially and an additional four hours annually. This training is required to start within 90 days of the laws going into effect. The care units are also required to have a “therapeutic activities director,” who will have the specific job of planning meaningful activities appropriate for the residents with dementia.

In addition to these changes, each facility with dementia care units will be required to have a fence to prevent the residents from eloping and injuring themselves. There was also a suggestion to prohibit overhead paging systems, which could potentially startle dementia patients, in the care units, but the standard was not added because of the costs that shutting the systems off would have. Also included in the new standards is the mandate that all nursing homes, including those without dementia-specific care units, must provide dementia training for all direct-care employees.