Violence against my DH in an AL facility

fmb

My DH is 92 yo, frail, and in a Broda chair. He lives in AL. He has early Stage 7 ALZ (though still somewhat verbal), stroke damage, and CHF, with an estimated less than 3 mos. to live.

Today there was an incident in the special needs dining room at lunch that has me very concerned. 

While the residents were eating lunch, another resident was seated across from DH, I was on DH's left. This other resident seems to have some sort of advanced dementia, is probably at least 20 years younger and quite a bit larger and stronger than DH. He is also in a Broda chair, but I saw him stand up just last week. Both men were eating when suddenly the other resident began bellowing threats at DH, pointing at him and angrily yelling "Get Out!" and other somewhat unintelligible threats. This resident also shook his fist across the table at DH's face and pantomimed cocking and shooting a shotgun at DH's face. DH was not even looking at him and had done absolutely nothing to provoke this kind of reaction. 

A Med Tech was in the room hand-feeding another resident and told the belligerent resident that if he continued that behavior, he would be taken up to his room. Fortunately the behavior stopped immediately. The resident remained in the room, across from DH and me for the rest of lunch. Because DH was still eating and I did not want to provoke a negative reaction from either man, I did not remove DH from the room at that time.

Needless to say, this incident shook me, though I don't think DH really understood the danger he was in. I don't know what would have happened if the resident could have reached DH or if he had thrown something at him. I am very concerned for DH's safety. DH has to be monitored while he eats (choking & aspiration), so eating in his room is out of the question.

This facility does have a MC section on site. In my non-expert opinion based on observing this other resident nearly every day at lunch, he should be in MC.

I emailed the facility director this evening and requested that my narrative of the incident be on the record. What should I realistically expect the facility to do in a situation like this?

 

M1

Fmb, are you living with your husband? Would he not benefit from MC also? I just ask because the ratio of residents to staff may be better. I'm sure this was very unnerving and am sorry it happened.

harshedbuzz

@fmb

I am so sorry this happened. How awful and scary. How fortunate you were there. Is this other resident known as having a potential for verbal or physical aggression? My take on this is either that the tech is aware that things have never escalated to a physical action which resulted in their lack of urgency. Sometimes facilities use a Broda as a means to contain a resident who needs 1:1 attendance by adjusting the seat to make it difficult-- but not impossible-- to get out of. It gives staff time to be proactive. At dad's MCF, there was one resident known to act out-- she lunged and punched me once-- she was never out of her room without 1 or 2 aides to intercede proactively.

I think this is worth a discussion with the DON to avoid another incident. Ask about their plan to keep you DH safe from this person. If this is a known behavior, they may have a plan for a geri psych admission or something-- the details may not be shared with you for reasons of privacy.

My thought is that your DH might be the one better served by the MC wing at the facility because they tend to have better staff rations and more training around dementia-driven behaviors. Now that this other resident has a history of verbal aggression, housing him with the more vulnerable population would not be appropriate under the circumstances.

HB

fmb

@M1 and @harshedbuzz

Thank you both for responding. I met with the Facility Director and the DON this morning. My inquiry into MC placement for DH's protection was immediately rejected. There is only one aide in the MC section with a maximum census of 12 residents. The aides are not MC trained and are rotated around the AL and MC sections. A Med Tech is in the MC some of the time. Because DH is under hospice care with a very limited life expectation, they do not consider MC an appropriate placement.

Their solution is to keep the two men apart in this small dining room. There is supposed to be a staff member in the room at all times that the residents have food, but there have been many times when I was the only non-resident in the room. Supposedly the aides and MTs will be instructed that the other resident is to sit at a table by himself. This resident's girlfriend usually comes in at lunch to feed him, though she was not there the past two days. When she came in today and was informed that he was to sit by himself at a particular table, the girlfriend said, "Did he act out again?" The DON met with her after lunch and explained the situation. I was told in past conversation with the girlfriend that he was in another facility prior to coming to this one a few weeks ago.

I am there with DH during lunch but cannot be there for breakfast or dinner. I am very skeptical about whether this plan will actually be carried out for more than a day or two. Fortunately DH and the other resident did not remember yesterday's incident, and today's lunch was uneventful. I am not happy about the new arrangement, but at this point all I can do is pray that nothing else happens.

M1

Sounds like they are understaffed and I’m sorry. I’m glad you have hospice for whatever additional help they can offer. At least it also sounds like his girlfriend understands the situation….

jfkoc

I agree...someone with advanced dementia should not be living in an assisted living facility.

Please let us know what the director of nursing has to say.

fmb

@jfkoc

The response from the Director of Nursing is above.

@M1

Technically they are in compliance with Pennsylvania regulations for AL. MC is not regulated separately. Realistically they are understaffed, but so is everyone else. This is actually one of the better facilities in the Pittsburgh region. It was also one of only three in the metro area who would take a 2-person assist transfer resident. Due to the high elderly population in the area, resources are spread extremely thin. When I first looked into placing DH, I looked into MC. Most places told me that unless he was an elopement risk, they would not take him.

Quilting brings calm

This is so hard. Everyone is trying their best to take care of their loved one. The other man’s loved ones can’t take care of him because it’s not safe for them, so they place him. Meanwhile you’ve placed your loved one to keep HIM safe. Only to have your needs turned upside down by another PWD. There’s got to be a better way than what passes for dementia care in this country. We should be able to find a way to take care of both peaceful and non peaceful PWD. It’s not going to happen until the powers that be admit that we need secure facilities for violent people of unsound mind( whether it be mental health or dementia). And provide those facilities instead of telling their families that they are on their own. And then watching the inevitable tragedy happen.

M1

We have a similar situation brewing currently, a resident who is likely to be expelled because they recognize no spatial or personal boundaries and are keeping all the other residents and staff tied up in knots. They would need one on one supervision 24/7 in order to be able to stay. The agitation during meals is palpable. I feel very bad for the family.

harshedbuzz

@fmb

I do hope they pull through for your DH.

I'm on the other side of the state in an area well-served by facilities of all stripes. The way licensing was explained to me, is that MC licensing is under the umbrella with "Personal Care" which offers more hands-on assistance and well checks than traditional hospitality model AL.

PA DHS Adult Services Manual, Section 2600 Personal Care Homes, Secure Dementia Units 2600.231-2600.239

Section 2800 deals with Assisted Living facilities.

PCH-ALR-Compliance Guides (pa.gov)

At this point, with you visiting daily and hospice on board, it probably doesn't matter. Perhaps they're trying to keep numbers down on the MC side because of staffing issues. I hope this is the end of it.

HB

fmb

@harshedbuzz Thank you for the clarification on the PA licensing. DH was first (briefly) in a personal care home. They were even less well staffed than his current residence, and the level of care was severely lacking. (He suffered a serious fall, and they didn't call an ambulance for over 24 hours.) At his current AL residence, they offer three levels of enhanced care above the basic AL room rate. Due to his need for medication management, a permanent Foley, and the special needs dining room, he is in the second level with a $1750 charge each month. If hospice was not providing the Hoyer lift (necessary due to severe swelling from CHF), that would be an additional large charge, too. My only other option was a SNF at $14,000 - $18,000/month, and most of the SNFs that I contacted wouldn't even return my call, despite being private pay.

@Quilting brings calm I couldn't agree more about the deplorable state of care for those with dementia and/or mental health issues and even just our elderly in general. You can always tell a lot about a society by how they treat their most vulnerable populations.

@M1 I pray that the issue at your dear partner's MC is resolved soon. No one should have to live in a situation like that.