Resident-on-resident abuse a common problem at nursing homes
19th October 2015 · 0 Comments
By Melinda Miller
Contributing Writer
BUFFALO, N.Y (Special from Buffalo News/New America Media) – When families need to find a nursing home for a relative who can no longer live at home, they worry about the facilities, the food, the medical care and the staffing.
They rarely think about one of the biggest trouble areas that nursing homes have to deal with on a daily basis: resident-on-resident abuse.
Slaps and Shoves
Stories about such incidents abound. Personal items are pilfered from residents’ rooms and some residents have a habit of wandering into places they are not wanted and don’t belong. Conflicts could involve cursing or insults. Some disagreements escalate to slaps or shoves.
A recent study found that one of every five residents experiences some form of aggression at the hands of other residents every month.
And, just as in mainstream society, anger and aggression can occasionally lead to serious physical assault. Every year, several homicides result from attacks by nursing home residents.
Individually, serious assaults among nursing home residents are rare and shocking. But taken together, they are part of a pattern of negative resident-on-resident encounters that has been documented and reported on by a team of researchers from the Weill Cornell Medical College in New York City.
The researchers surveyed about 2,000 people living in 10 skilled nursing facilities in New York State to track inappropriate, disruptive and hostile behavior between residents – and found it to be surprisingly common.
The offenses ranged from the merely irritating to the physically threatening. Researchers discovered:
• Nearly 6 percent of residents were involved in hitting, kicking or biting.
• 16 percent of the cases were in the form of screaming or cursing at people.
• A small number – less than 2 percent – exposed their genitals or made unwanted sexual advances.
• And there were various instances of scratching, spitting and throwing things.
• More than 10 percent of the residents experienced “unwelcome entry into another resident’s room or going through another resident’s possessions” – a seemingly minor offense, but the type of behavior that can trigger an angry physical response from the person who is intruded upon.
When Residents Act Out
That’s what happened with Anthony Szczygiel’s family member. Szczygiel is director of the William and Mary Foster Elder Law Clinic at the University at Buffalo, and he has seen elder care problems from both the legal and the personal side.
His mother-in-law, who had issues with confusion, wandered into another room, and the person there didn’t like it, he said.
“She was pushed and fell, and she broke her wrist,” Szczygiel said. “Residents sometimes do act out, and that acting out can result in discomfort, or worse, for other nursing home residents.”
He added, “The study really does call into question how safe it is to go into a nursing home.”
He doesn’t fault the homes’ administrators.
“They have a difficult task. They have residents with a wide range of abilities and you have to provide for them 24/7,” he said. “They aren’t able to offer the best jobs and the best pay – it’s hard work – and staffing can be a problem.”
Beyond that, however, he sees value in the report. By taking a closer look at how nursing home residents mistreat one another, elder care professionals can work on better ways to prevent it. Szczygiel says administrators need to set the right tone their employees, so they understand what it takes to keep the facility above and beyond the “safe and adequate” standard set by the state.
Cause and Effect
Karl Pillemer, PhD, professor of gerontology in medicine at Weill Cornell, conducted the resident abuse study with Mark Lachs, MD, medical director of the New York City Elder Abuse Center. Pillemer reported on their findings at the last annual Gerontological Society of America Scientific Meeting in Washington.
The researchers also are more interested in solutions than blame.
Pillemer said that it can be hard in a nursing home to distinguish who is the aggressor when residents mistreat each other. The report deliberately characterizes residents as being “involved” in negative interactions, rather than taking sides.
“It’s hard to separate perpetrators from victims in a lot of these incidents,” Pillemer said. “People who typically engage in resident-on-resident abuse are somewhat cognitively disabled.”
Defining the risk factors that can lead to more resident-on-resident mistreatment is easier. Places that reported more incidents share similar characteristics:
• Conditions were more crowded and there was less private space. This forced more unwanted interactions.
• Understaffing and low staff-to-resident ratios were common.
• Ongoing conflicts between residents were more likely to go unresolved, and being around ongoing hostility stressed out other residents.
• Staff members became so desensitized they begin to view the conflicts as normal behavior.
Residents who are involved in aggressive encounters also have things in common. While some are older, most tend to be relatively younger people who suffer from dementia or other mental illness, and they are usually mobile and physically able.
“Often their underlying dementia or mood disorder can manifest as verbally or physically aggressive behavior,” said Pillemer.
Because they are limited in their movements, the residents can feel like they aren’t in control of their situations – almost like they are prisoners – and respond aggressively.
Coping Mechanisms
The ability of caregivers to relieve uncertainty and defuse frustration directly affects the atmosphere is a nursing home, according Davina Porock, associate dean for research at the University of Buffalo’s Institute for Person Centered Care. The Institute is at the forefront of reinventing how patients, especially older patients, are treated. Many of the practices it recommends also were echoed in the Weill Cornell study.
Porock said it isn’t accurate to consider aggression a “symptom” of dementia.
“Aggression is a response to the frustration caused by the illness,” she said. “‘Abuse’ is a hard term. Are they abusing the person, or are they in a state of fight-flight?”
She uses the example of a dementia patient whose still has awareness, but who processes information more slowly. Visitors and caregivers need to take that into account, she said.
“Often, at home or in a nursing home, they aren’t given time to respond. We have this terrible habit of asking people a lot of questions – ‘What have you been doing today? How are you’ – and when they try to answer, they get stuck. Maybe they can’t remember the word and they’ll use a substitute that may not be related. If the other person is not attentive, they’ll say, ‘OK, you’re out of it today.’ For a patient, that can be highly irritating.”
And sometimes, it can be infuriating.
“In nursing homes, whenever you have two or more people having these problems, there already is a point of conflict,” Porock said.
Staff can address confused behavior with regular checks on difficult residents and by learning how to gently handle residents who are in the wrong place or doing the wrong thing.
Need to Understand Underlying Triggers
This follows the recommendations of Pillemer and Lachs, who see a strong need for better guidelines for those on the front lines, so they understand the underlying triggers for the acting out.
“Why is this person wandering around?,” Porock says. “My idea is they are bored. Just because you have dementia doesn’t mean you don’t want something to do.”
Porock said research in her department has shown that increasing worthwhile social interaction and physical activity helped adults with memory problems get more sleep, and that in turn reduced anxiety and they became less aggressive.
“Without these policy and practice changes,” she said, “there will be a growing incidence of aggression as staff and residents deal with the stressors of institutional life.”
This article originally published in the October 19, 2015 print edition of The Louisiana Weekly newspaper.
