Neglect or Dementia?

Eilon Caspi is the Assistant Research Professor of Health, Intervention, and Policy at the University of Connecticut. He wrote a fantastic article about resident to resident assaults in nursing homes. These preventable incidents are prevalent in nursing homes.

He is a gerontologist and dementia behavior specialist. He literally wrote the book! His film, “Fighting for Dignity,” explains the emotional trauma caused by these preventable incidents in nursing homes.

The last two years has seen an uptick because of short-staffing, lack of visitation, and social isolation. Nursing homes fail to report these incidents. CMS ignores the problems so incidents remain an unaddressed problem.

Should we blame neglect or dementia for these incidents?

Resident-to-resident incidents are defined by researchers as “negative, aggressive and intrusive verbal, physical, material and sexual interactions between residents” that can cause “psychological distress and physical harm in the recipient.” That is broad. As it should be to protect the most vulnerable among us.

Research shows that most incidents between residents are preventable. Lack of assistance and supervision caused by short staffing is the major risk factor. Too many residents with dementia with too few caregivers. One U.S. study found that higher caseloads among nurses’ aides were associated with higher incident rates.

Two of every three residents involved have dementia. Episodes occur nearly three times higher in dementia care homes than in other long-term care homes. And a study on fatal incidents in U.S. nursing homes has shown that many residents were “deemed to lack cognitive capacity to be held accountable for their actions.

“A growing body of evidence suggests the true cause of these injuries and deaths is inadequate care and neglect on the part of care homes. Specifically, there is a lack of the specialized care that people with dementia require.”

Conflicts occur because the caregivers fail to provide for the residents’ nursing and custodial needs. Unsafe staffing increases episodes of neglect. Frustration leads to outbursts. Those with advanced dementia say do things that trigger angry reactions in other residents. The strongest triggers involved personal space and possessions.

Other research shows that when residents are bored or lack meaningful activity, harmful interactions increase. Conflicts between roommates are also common and harmful. Another reason single rooms are best.