Disruptive Behaviors I. Articles on Dementia / Aggression A. Nursing homes resident

273 Pages·2016·15.39 MB·English

Table of Contents for Extended Learning for: Disruptive Behaviors

I. Articles on Dementia / Aggression
A. Nursing homes resident's aggression studied
B. Four steps to deal with difficult elderly behavior

II. Evaluation of Medication
A. Beers
B. 699 Stop/Start criteria

III. Alzheimers Association list of diseases containing a dementia element
A. Mixed Dementia
1. Cruetafeldt­Jakob disease
B. Alzheimers Association
1. Alzheimers
2. Parkinsons
C. Tests for Dementia

IV. Survey Information
A. Survey Tests ­ Dementia. Survey and certification 16­04
B. Survey clinical standards ­ dementia. Survey and certification 16­28
C. Survey checklist. Surveyor checklist 13­35

V. Medicare Guidance on elder abuse
A. Aligning CMS FAQ
B. Abuse Prevention
C. CMS 20059 Abuse
D. Federal article on elder abuse
E. 07­13­00010 abuse
F. PET Scan
Table of Contents for Extended Learning for: Disruptive Behaviors

I. Articles on Dementia / Aggression
A. Nursing homes resident's aggression studied
B. Four steps to deal with difficult elderly behavior

II. Evaluation of Medication
A. Beers
B. 699 Stop/Start criteria

III. Alzheimers Association list of diseases containing a dementia element
A. Mixed Dementia
1. Cruetafeldt­Jakob disease
B. Alzheimers Association
1. Alzheimers
2. Parkinsons
C. Tests for Dementia

IV. Survey Information
A. Survey Tests ­ Dementia. Survey and certification 16­04
B. Survey clinical standards ­ dementia. Survey and certification 16­28
C. Survey checklist. Surveyor checklist 13­35

V. Medicare Guidance on elder abuse
A. Aligning CMS FAQ
B. Abuse Prevention
C. CMS 20059 Abuse
D. Federal article on elder abuse
E. 07­13­00010 abuse
Related Articles and Cases
Nursing Homes Residents’ Aggression is Studied

Columbia Dispatch, Saturday 13, 2014 5:37am

When people talk about abuse in nursing homes, they generally are referring to staff
members victimizing the elderly.
But researchers say an even more pressing, prevalent problem might be the violence
that can — and does — erupt between residents.

According to a new study by Cornell University, nearly 1 in 5 people living in nursing
homes is involved in at least one aggressive encounter each month.
“These altercations are widespread and common in everyday nursing­home life,”
said Karl Pillemer, who is a professor at Cornell and at the Weill Cornell Medical
College and a co­author of the study.

Resident­to­resident mistreatment is under­reported to the point that, at some long­
term­care centers, “staff members seem almost unaware,” Pillemer said.
Nursing homes provide care for about 1.5 million older Americans nationwide,
including about 90,000 in Ohio. By 2030, the number of U.S. adults 65 and older will
more than double, to about 71 million.

Research has mostly focused on older adults who have been mistreated by their
family and caregivers in the community or by staff members in nursing homes, said
Dr. Mark Lachs, who is the other author of the report and a professor of medicine at
Cornell’s medical college. But resident­on­resident violence is a much bigger
problem, with consequences that can be just as devastating, he said.

In addition to cuts, bruises and broken bones, verbal and psychological violence can
lead to depression and feelings of hopelessness — and, in worst­case scenarios,
death, said Lachs, a practicing geriatrician.

Last month, for example, a 66­year­old woman strangled her 57­year­old roommate
at a Georgia nursing home. Staff members reported hearing arguing late at night.
“There are a number of these murders every year, and it’s not something to be taken
lightly,” Lachs said.

As part of the study, the Cornell team examined patient records at 10 nursing homes
in New York. The group also interviewed residents and direct­care employees such
as aides. Research assistants spent two to six months at the centers recording
incidents they saw.

Of the more than 2,000 residents, 16 percent were involved in verbal incidents such
as cursing, screaming or yelling; about 6 percent were involved in physical violence,
including hitting, kicking or biting; and 1 percent were involved in sexual encounters
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such as exposing one’s genitals, touching other residents or attempting to gain
sexual favors.
Another 11 percent experienced incidents such as residents walking into their rooms
uninvited or going through their possessions. All of the events were “unwelcome
with a high likelihood of causing physical or psychological distress,” Lachs said.

Residents also commonly take out their aggression on nursing­home employees,
which is the subject of another Cornell study, he said. Younger residents who have
dementia or a mood disorder but are physically healthy enough to move around are
more likely to be involved in aggressive incidents, he said. Depression also seems to
be a factor. Crowded conditions, understaffing and ongoing conflicts between
residents can fuel conflicts, he added.

Dr. Laura Mosqueda, a practicing physician and director of the National Center on
Elder Abuse, said nursing­home residents often have complicated medical and
behavioral conditions that can cause personality changes. But Mosqueda cautioned
against treating these incidents as typical abuse situations, with clear perpetrators
who need to be punished.

“These are some of society’s most­vulnerable citizens, and in many ways, the
aggressor and the aggressee are both victims,” said Mosqueda, who also teaches at
the University of Southern California’s medical college. When incidents arise,
nursing­home workers should try to trace the warning signs and underlying causes to
prevent future altercations, she said. If, for example, inadequate staffing is part of
the problem, then the center should hire more employees and consider paying them
more to keep them. If two residents don’t get along, they shouldn’t be living in the
same room or eating at the same table.

Beverley Laubert, Ohio’s long­term­care ombudsman, said the state receives
relatively few complaints about resident­to­resident violence. But it has caused
serious problems for a few nursing homes. In August, state health officials moved 37
residents from a XXXX nursing home that had been plagued by resident assaults,
including hitting, punching, shoving and kicking.

And in February, a long­troubled nursing home in southwestern Ohio that had more
registered sex offenders than any other in the state closed because of repeated
violations that included not reporting suspected sexual abuse. “It’s not always an
easy thing to handle,” Laubert said. Once, she said, she walked up to a nursing­home
resident, and he started to yell at her. “Staff snapped back, ‘Stop it, stop it,’ when a
more­proper response would have been to say, ‘ John, this is Bev,’ so he would have
known to trust me,” she said.

Having high numbers of residents with behavioral problems and mental illnesses can
be especially difficult, said Peter Van Runkle, the executive director of the Ohio
Health Care Association, a nursing­home industry group. But it’s no excuse, he said.
“We have folks who don’t intentionally do the things they do,” Van Runkle said. “But
the reality is, none of it is acceptable, and our goal is for it not to ever happen.”
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The keys, he said, are determining any history of aggression before a resident moves 
in, figuring out what might cause a resident to become violent and having plans in 
place to prevent future outbursts. 

“Facilities are very aware of the problem,” said Jane Straker, a senior researcher at 
the Scripps Gerontology Center at Miami University who has studied resident­on­
resident abuse. The questions are, whether nursing homes will do more to find ways 
to reduce residents’ mistreatment of one another and whether there is enough 
pressure from state and other officials for them to try, the Cornell researchers said. 
Mosqueda of USC agrees. “One of the challenges is, we have a system where it is up 
to nursing homes to pretty much police themselves,” she said. 

The Cornell team recommends that nursing homes train staff members to recognize 
and report mistreatment, provide guidelines for when incidents occur and use 
approaches that consider the individual needs and abilities of the residents. 
“I think the answer lies with thoughtful behavior interventions that don’t rely on 
drugs,” Lachs said. 

Dispatch Reporter Encarnacion Pyle wrote this story with support from the Journalists
in Aging Fellows Program of the Gerontological Society of America and New America
Media, sponsored by the Silver Century Foundation.  

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Resident-Resident Assault Prompts Wrongful Death
Lawsuit

Posted on behalf of The Bell Law Firm, PLLC on Oct 17, 2012 in Nursing Home
Information

Nursing home operators in West Virginia have a duty to protect those who've been
entrusted to their care from physical abuse by staff members, visitors, trespassers and
other residents alike. When they fail to do that, victims have the right to hold the
facility accountable and seek compensation for the harms they've suffered as a result
by filing a nursing home negligence lawsuit.

We recently came across a story about a wrongful death lawsuit involving exactly this
type of scenario and wanted to share it here for readers who may be interested.
According to reports, an assisted living facility in New Jersey has been sued in
connection with the wrongful death of an 85-year-old female resident in Oct. 2008.
Her family's complaint alleges that the facility not only failed to protect their loved
one from being brutally choked by another resident, but that staff members were also
grossly negligent in failing to treat the woman's injuries for several hours afterward.
Prior to the choking incident, the complaint claims that the victim told staff members
that the male resident who later assaulted her had been harassing her. The complaint
further alleges that the staff also "knew or should have known that the aggressive
resident had already attacked other residents of the facility" and should have done
more to protect her rather than just simply telling her to avoid the man.
The family is right, of course, yet the facility has maintained that the incident was
handled appropriately and that its staff members reacted quickly. We'll provide an
update on this nursing home negligence story and wrongful death lawsuit as soon as
there are new developments.

Source: MadisonPatch.com, "Wrongful Death Suit Filed Against Morris County
Facility," Sept. 20, 2012

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Nursing Home Sexual Violence: Chicago, Illinois
ABC news recently reported on a resident sexual assault in an Illinois nursing home.  According to 
the report, authorities are investigating the assault of an 86­year old nursing home resident with 
Alzheimer’s. The crime was allegedly perpetrated by a 65­year old man who was also a resident 
of the nursing care facility. 
The man posed a risk that required at least some caution on the part of caregivers. The nursing 
home was aware that the alleged perpetrator was a registered sex offender under Megan’s Law 
which requires warning and public notification of living arrangements for those with a history of 
sexual crimes. 
For residents who suffer from Alzheimer, abuse is quite common in a nursing home. In fact, 
recent studies have shown Alzheimer patients are more likely to suffer some sort of abuse than 
patients with other diseases. With aging it is expected that memory loss will occur, however, 
Alzheimer is beyond what a normal person should suffer while getting older. Many of times a 
patient who suffers from Alzheimer and is abused, will not remember or cannot recall the 
incident. 
February 8th, 2013 Posted to Resources, Sexual Abuse

Nursing Home Staff Fired From Reporting Sexual Abuse
Of Resident
Nursing home employees are obligated to report any resident abuse they are aware of, even if 
the act of abuse is being committed by one of their co­workers.  Nursing home abuse is all too 
common, and the fear of consequences should never deter someone from reporting the abuse. A 
lawsuit was brought against one nursing home, because a former employee feels she was 
terminated from her employment because she made a report to the police department that a 
fellow male co­worker was sexually assaulting a 93 year old patient residing in that home. 
The former employee is seeking $30,000 in compensation under the whistle blower protection 
law. After reporting the sexual abuse, the employee stated that she felt her boss’s demeanor 
towards her had changed.  The bosses were afraid that the attack could portray the nursing 
home in a negative light, giving them a poor reputation. 
Sexual abuse of nursing home patient, or any form of nursing home neglect should always be 
reported, and employees should never hesitate because they feel their jobs may be put in 
jeopardy. It is the nursing home employee’s responsibility to protect their residents, even if it 
means reporting abuse or neglect of a patient by another member on staff. 
Nursing home residents are extremely vulnerable due to their medical conditions, including 
dementia and Alzheimer’s disease.   This makes these residents vulnerable to sex abuse by staff 
members and other nursing home residents.  In addition, nursing home residents are often weak 
and unable to communicate to other the fact that they have been sexually victimized and 
therefore many of these incidents are unreported.  (more…) 
January 28th, 2013 Posted to Sexual Abuse

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Sexual Abuse of Dementia Residents in Michigan
Nursing Home – Buckfire and Buckfire P.C.
Buckfire & Buckfire P.C has experience with filing lawsuits on behalf of families for sexual abuse 
of dementia patients at a Michigan nursing home.  In fact, unknown to many, sexual abuse is 
very common in our long­term care system. Many elderly, who have dementia, are exceptionally 
vulnerable to sexual predators.  
Michigan nursing homes can easily claim that the complaints of sexual abuse are the 
manifestations of dementia or delusional thought processes. Even when sexual abuse is 
apparent, nursing homes rarely act to preserve important evidence and there are rarely credible 
eye witnesses that are willing to come forward and testify to physical or sexual abuse. If you 
suspect that your loved one who suffers from dementia is being sexually abuse, it is very 
important that you contact an experienced nursing home neglect attorney immediately to 
discuss your case.  
Michigan Nursing Home Residents Sexually Abused By Other
Residents
Resident to resident sexual abuse is more common than staff sexual assaults upon residents. 
Many nursing home residents with dementia may act out sexually and inappropriately, but this 
does not constitute the assault. Sexual abuse by a stranger or visitor can occur where the nursing 
home has not provided adequate security to protect its residents. While a nursing home should 
generally accommodate visitors request to see patients, even at odd hours, they have an 
obligation to make sure that the visitors are not dangerous or otherwise causing harm to the 
residents. Nursing homes generally track the individuals who visit the facility, but in busy nursing 
homes this may not be consistently done. 
Prevent Sexual Abuse of Dementia Residents in Michigan Nursing
Homes
Even though most nursing homes staff undertakes background checks, which should reveal the 
existence of any prior crimes, these background checks are usually limited in scope and may not 
pull up convictions in other states. Sexual abuse in the nursing home setting can be committed 
by staff members, other residents or on occasion by visitors. In cases where sexual abuse has 
been performed by a staff member, the facility may take the position that it should not be held 
liable for the criminal conduct of its employee, if such criminal conduct was never authorized by 
the nursing home.  This act of abuse is unacceptable and the nursing home is responsible for 
proper supervision of their residents and appropriate behavior from their staff. (more…) 
January 25th, 2013 Posted to Sexual Abuse

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Resident on Resident Abuse – a Basis for Even More
Lawsuits Against Long Term Care Facilities?
by Eric Naegely 
October 5, 2015  11:06 AM 
HEALTH CARE  

The Buffalo News recently published a colorful article about resident on resident 
abuse in long term care facilities.  The News labels such abuse as a “common 
problem” citing a 2014 Cornell University study that found one in every five long 
term care residents experiences some form of aggression at the hands of other 
residents  The study focused on only New York based facilities.  Thankfully, the
Buffalo News article also states that serious assaults among residents are very rare 
and that the Cornell study in no way placed blame on facility administration or staff. 
So, there is nothing to be concerned about, correct?  Not so fast!  An internet search 
reveals numerous plaintiffs’ law firms have cited to the Cornell study, on their 
websites, in an effort to market the issue to the general public.  These law firms 
reference only certain portions of the study leaving out those findings that actually 
support the facilities, such as the rarity of serious assaults.  The result of these 
marketing efforts will certainly lead to lawsuits. 
Analyzing our ability to successfully defend against these lawsuits can be done only 
on a case by case basis.  However, the legal theories to be used by plaintiffs’ 
attorneys are not difficult to predict.  Many of the web blogs already set forth legal 
theories such as the general duty to keep residents safe from harm and the duty to 
provide close supervision on all residents.  The specific claims of negligence will likely 
include the familiar allegations of insufficient staffing and/or the failure to 
implement proper policies and procedures.  Expect to also see corresponding 
complaints made by residents to the Department of Health.  Plaintiffs’ attorneys 
often instruct their clients file such complaints so they can then utilize the DOH 
findings to help shape and support their case. 
The absence of a significant physical injury will likely not be a deterrent.  New York’s 
Public Health Law 2801(d) allows a resident to commence an action without first 
sustaining a physical injury.  The statute also allows a resident to seek punitive 
damages in more egregious cases such as if a facility admits a known dangerous 
resident or fails to remove a resident with an abusive past. 
It is always best to address a potential lawsuit or government investigation as soon 
as possible.  Call your experienced health care attorney immediately after any 
incident involving resident on resident abuse. 

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Vulnerable adult beaten by her caretaker at Hopkins,
Minnesota assisted living facility
By Kosieradzki Smith Law Firm February 24, 2016
The Minneapolis Star Tribune just published a report, entitled “Hidden camera
catches beating of elderly patient at a senior home; Secret video leads to abuse
charges against an aide at a XXX nursing home.” Reporter Chris Serres reports:
“An aide at a Hopkins senior home has been arrested and charged with two
counts of assault after videos from a hidden camera showed her repeatedly
hitting an elderly patient in the head.”
XXX, 55, was arrested Feb. 7 after video footage showed her assaulting the
patient on at least two occasions at the XXX senior home. Videos showed XXX
striking the patient several times in the head and back with her hand, elbow and
even a hair brush. Footage also showed XXX roughly pulling the patient up from
the floor by her hair, according to a police report.”
“‘You see a lot of things in our job that are bad, but when someone is defenseless,
that makes it the most disturbing part,’ said Police Sgt. XXX, who watched the
videos. ‘You think about your own parents and grandparents.'”
“Increasingly, relatives are turning to hidden cameras, also known as ‘granny
cams,’ as a way to detect abuse and neglect in senior homes. The cameras can be
so small they go unnoticed by staff members.”
“This marks the second time in eight months that caregivers at Twin Cities­area
senior homes have been caught on camera allegedly beating residents. In July,
two employees at XXX were fired, and nine others were suspended, after videos
installed by family members caught them abusing at least two residents.”
“In a Feb. 12 letter to residents and relatives, XXX administrator XXX referred to
the incident as ‘detestable’ and ‘deeply offensive to us as people.'”
“The senior care community, which has XXX beds on its sprawling campus, has
fired XXX and has begun reviewing with each staff member the procedures for
identifying and reporting suspected maltreatment. The facility also has begun an
internal review of its hiring, training and supervisory practices, XXX said in the
letter.”
“‘This is completely contrary to everything we stand for,’ said XXX, a spokesman
for XXX, which is owned by XXX Senior Communities. ‘We are looking at
everything we do — how we hire, how we staff, how we train and how we
supervise — to see if there is anything we can learn from this.'”
“XXX is charged with one count of fourth­degree assault — a gross misdemeanor
— and one count of fifth­degree assault. She is scheduled for an arraignment on
March 14 in Hennepin County District Court in Minneapolis.”
“‘In a way, I was glad the video was there, because it helped us make our case,’
XXX said. ‘I give a lot of credit to the family for coming forward and doing what
they needed to do to confirm it.'”
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