An Emerging Form of Nursing Home Abuse

St. Paul, MNFor years the headlines have been rife with screaming misdeeds committed against the innocent residents of nursing homes—from staff grossly neglecting residents to actual cases of physical and verbal assault. But nursing home abuse can take many forms and nursing home neglect need not be sinister. Rather, a case for nursing home negligence can be made when nursing homes fail to protect abusive residents from one another.

Even the most carefully-run facilities are not beyond the need to find room for improvement.

Friendship Village in Bloomington, Minnesota is one of the top-rated nursing homes around. A State inspection in May of last year found five deficiencies, whereas the average for the state is 10. They run a pretty tight ship. And yet the attention to detail did not prevent an incident on Valentines Day that resulted in the death of a 97-year-old resident who was pushed to the floor by another.

The two men involved suffered from dementia, a debilitating disease that absolutely hijacks the mind. Verne Gagne, 82, suffered dementia as a byproduct of his Alzheimer's disease. It was on February 14th, near the nursing care station at Friendship Village, that the imposing Gagne threw the older and smaller Helmut Gutmann to the floor, breaking his hip. Gutmann, who suffered from vascular dementia, died of his injuries.

Gagne is a former pro wrestler. There had been a previous report of Gagne shoving Gutmann. It is not known if Friendship Village had written abuse prevention plans for both men, but such a detail is a state requirement in Minnesota. When Friendship Village was audited last May, one of the five deficiencies found involved a failure to address the behavioral problems of a resident prior to him becoming agitated.

"It happens with a frequency that we have yet to truly understand," said Mark Wandersee, executive director of the Minnesota ElderCare Rights Alliance, in comments posted online at the St. Paul Pioneer Press.

"How adequately staffed was the dementia care unit or the memory care unit?" Wandersee said. "Were there a tremendous number of adults with dementia congregating too closely with one another?"

If these kinds of things are happening at top-rated facilities such as Friendship Village, one can imagine what the future holds as the population ages and eldercare facilities fill up with residents. The arrival of the largest wave of baby-boomers to retirement and nursing homes will put even further pressure on the nation's Medicare, Medicaid and Old Age Security safety net that is already showing signs of stress—both fiscally and from a facilitative context.

If families cannot feel confident that a loved and vulnerable elder will be not only be properly cared for by facility staff, but also kept safe from the physical outburst of others, then what's the alternative?

Health advocates in the field of elder care stress that more has to be done to prepare for the wave and to foster a change of attitude with regard to seniors suffering from dementia. To that end, it has been reported that there is a need to refrain from treating seniors suffering from dementia as simply serving to be problematic.

An assisted-living center in Brooklyn Center created a specialized wing in 2007 expressly designed to handle dementia cases. Summit House has become not only a safe haven, but also an option of last resort when dementia patients become too much for other facilities without the manpower, or strategies to cope.

That situation is best illustrated by the case of an 88-year-old resident at an assisted-living center who swung his cane at a young facility worker. However the man's daughter maintains that such an incident could have been easily prevented had the facility worker been properly trained. The old gentleman was simply enjoying the company of a 'lady friend' in a common area. When he was told to go to his room, he became agitated and swung his cane. Rather than attempting, through proper training to diffuse the situation, the facility worker called police.

The resident, as a result was asked to leave. Summit House, in Brooklyn Center appeared to be his and his family's only option.

The key to a solution, according to Jennifer Anderson, is to view dementia as a symptom. Anderson serves as Chief Executive of Mirabelle Management, a consulting firm that has trained 125 Minnesota elder care health providers on the subtleties of dementia care.

"If we can anticipate that anxiety—or when it happens we have the tools to redirect it—then that anxiety won't roll into agitation, which then rolls into combativeness and anger."

That's an important observation, given that there is so much more to nursing home abuse than facility staff mistreating, or neglecting patients. Make no mistake, there is still lots of that happening and the number of ongoing lawsuits against the providers of elder care in nursing home facilities is testament to that.

However, an emerging problem is dementia, an issue that will only become exacerbated over time as the biggest wave of boomers retires. And nursing home negligence is more than simply mis-treating elderly residents. Abuse, negligence and nursing home neglect can also encompass the failure of elder facilities to protect patients from one another.