IDPH has cited and fined Alden Long Grove nursing home after one resident was assaulted by another resident.
Psychiatric medications are an important tool in the arsenal of caring for residents with dementia or other psychiatric conditions. However, the use of the medications and the effects and effectiveness of the medications must be carefully monitored. If a resident is over-medicated, this often has severe negative side effects and can set the stage for other issues such as malnutrition or dehydration, nursing home falls, or bed sores. However, if the resident is not receiving a sufficient dose of the medication, then the behavior which the medication was intended to address may not be altered.
When a resident has a dosage of a psychiatric medication changed, one thing that needs to also suffer be monitored carefully and care-planned for are changes in behavior.
The resident who was the assailant here here had a history of restlessness and agitation, vascular dementia with behavioral disturbances, and a mood disorder. He had expressed homicidal ideation toward a family member in the past and had other episodes of verbal aggression. The staff was aware that he did not get along with other residents, and was very territorial. As a result, he had a private room where he often stayed with the door shut.
He was receiving psychiatric care and was on a mood stabilizing drug. However, the dose that he was receiving left him sedated and as a result, the dosage was reduced. After the dosage was reduced, he began to demonstrate increased aggressive behaviors. The resident’s son raised this as an issue of concern with the staff who consulted with the psychiatric nurse practitioner who refused to restore the original dosage to avoid the sedating effects of the medication.
The resident who was the victim also suffered from dementia and had a history of wandering in and out of other resident’s rooms.
The incident occurred when the victim wandered into the resident’s room. The assailant told him to get out. A verbal altercation ensued and the victim threw some soup at the assailant. The assailant punched the victim in the head multiple times and was in the process of dragging the victim out by his heels when the staff intervened.
The victim suffered bruising and skin tearing about the face, but more alarmingly, had lost the ability to walk in between the time that the assault took place and the time that the investigation was conducted by the state. Loss of mobility is something that bodes poorly for the long-term well-being of nursing home residents.
Where were the shortcomings in the care provided by the nursing home?
With regard to the assailant, the staff did the right thing by notifying the nurse practitioner about increased aggression, but the key issue in that would be what was expressed and what data was available. Many nursing homes do behavior tracking in the resident chart which gives a more detailed, data-filled basis for making medical decisions regarding medication usage and whether that data was developed and whether it was communicated to the nurse practitioner are issues worth investigation. Further, increased verbal aggression is sometimes a precursor toward physical aggression in dementia patients. Knowing that this was going on, it is also worth investigating whether the staff on hand was aware of that through the 24-hour sheet reporting or nurse to nurse shift reports and what was done about that.
With regard to the victim, intruding on another resident’s personal space, wandering into their rooms, and failing to respect their belongings are often a flashpoint for conflict among nursing home residents, leading to a resident-on-resident assault such as this. If the resident was truly in the habit of wandering into others’ rooms, then this behavior needed to be addressed in the resident care plan.
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