Assaults in Nursing Homes

1-7-12

When someone mentions assaults in nursing homes, one thinks of staff attacking a poor, helpless resident. Maybe it’s pinching an annoying woman or giving a kick to bad-mouthed man. What most people don’t realize is that staff are more often hurt by residents than the other way around.

I’ve worked in nursing homes for almost 20 years and I’ve rarely seen staff deliberately harm patients (at least physically), but I’ve seen residents get frustrated and try to hurt their caretaker. All of them, of course, have dementia to a severe degree, which doesn’t make it hurt less. Most of the time, they are too weak to do much harm. The favorite action seems to be to grab the arm and twist. That usually doesn’t hurt. If they twist enough, all you have to do is lean in the direction of the twist to reduce torque on the arm. Sometimes they take both hands and twist your arm in different directions, like wringing a dishrag. That can be tougher on you, but even if it’s enough to hurt, it’s a simple thing to reach over and pry a thumb loose and the rest of the hand comes off. It doesn’t harm or even hurt the resident when you do that. The worst is when they grab your hair and pull. You can count on losing air with that. One resident seemed to like to grab the hand, separate out the pinky and twist it. One aid got her finger broken with that. They usually do these things when upset at having wet clothes changed or to get up to go to dinner. Usually they don’t believe they’re wet or that it’s time for dinner, etc.

My worst assault with a resident was a man who still had some strength and could walk and get around. I was coming back from the dining room to get something from the nurse’s station when I found “Chuck” pushing “Tom” around in his chair. Tom was a double amputee and was already frightened of Chuck who was his roommate. Chuck got an angry look over his face when Tom yelled in fear and brought up his right hand to do a kind of karate chop on Tom’s left neck. By then I’d broken into a run and as I arrived I put my body in front of Chuck, between him and Tom’s wheelchair. I’ve found that in talking to an agitated resident, it’s best to look right in their eyes, so I kept my eyes on Chuck’s face and started talking as I gently pushed Tom’s chair away. After I was sure Chuck wasn’t going to immediately punch me or something, I stepped back a bit and glanced around to see if Tom was severely injured. He was wheeling himself away, so I turned back to Chuck and tried to coax him back to his room.

Chuck had problems keeping his blood oxygen up, but refused to keep his oxygen on, couldn’t remember to keep it with him. When his oxygen levels dropped, he frequently got combative and agitated and generally improved when his oxygen tubing was replaced. That’s why I tried to get him to his room. I didn’t want to leave him alone and no one else was around except residents returning from lunch. About halfway there, he stopped and grabbed my right arm and twisted it to my right. His grip was stronger than any I had experienced and I couldn’t break his grip my usual ways so I had to lean right to lessen the torque and keep him from breaking my arm. I kept trying to loosen his fingers when he suddenly grabbed a big bunch of hair and pulled. I then grabbed that hand to keep him from pulling it out and then was stuck for something to do. I’d worked a lot of night shifts so it was second nature to me to remain quiet no matter what since usually there was a way out. But now I was stuck. So I deliberately started to yell for help, trying not to sound like a resident with a habit of always screaming that was there. After a couple of yells, he turned loose of me and stepped back looking confused, like, ‘Why is she screaming?’. An aid came along and helped me get him to his room and put oxygen on him.

My hair fell out as I tried to fix it up and left a bald spot on my left top forward part of my head. Chuck was sent out to the hospital and from there to somewhere else for difficult people with dementia, which surprised me. The last place I’d worked kept everybody regardless of what they did except one who tried to assault the administrator. HE got sent out!

Most of the time agitatable dementia patients can be treated with anti-psychotic meds or antidepressants. Since in the early part of the twentieth century when patients were routinely sedated for the convenience of the staff, state laws have forbidden such things. Many inspectors of nursing homes get down on use of these meds, but I hardly think preventing assaults is a convenience. Also, an agitated person is clearly not happy, but fearful and confused. Assaults are a result of the delusional resident fearing harm. I’ve seen patients go from getting angry all the time to cheerful and start to participate in social activities. How can that be bad for them? Today’s medications are much less sedating than those available in the forties and fifties.

I totally agree that abuse of the elderly is unacceptable and people who do this deserve what they get. I once found a mute resident left in her bed during dinner while her aid was in the dining room feeding people, clearly not going to get this woman up for dinner. I also remembered that this resident was missing from dinner the night before. “Mary” was helpless, unable to complain and I was very angry. I immediately went to the supervisor to complain and the aid was fired. I don’t know if her license was suspended, I hope it was. In most places, there is usually someone who cares about the resident and who will stand up for them.