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She was punched several times in the chest and arms and shoulders by a gentleman residant. She is in a wheelchair and quite frail and unable to protect herself. She is not in a lockdown unit and is free to go to activities provided in the residance which she enjoys and avails herself of. I understand the gentleman in question has had episodes of violence before. I do not blame him as I would imagine his medication must be in need of adjustment or perhaps he is in need of transfer to a lock down unit if his behavior is becoming unpredictable. His family is extremely distraught but my Mother has been left bruised and frightened. It is difficult for all concerned. How do I best make it clear that I will not tolerate my mother being assaulted and who is ultimately liable for her safety. Is it the nursing home? Am I correct in asking for their policy and procedure in cases like this and what they intend to do about it. Their attitude seemed to be simply to file an incident report. Thank you for any help you can give me in how to best handle this in a civilized but firm manner.

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Revers... I admire you for being able to do it. It takes a special person, and so much patience. God bless you.
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My Mom has alzheimers and I take care of her and hired help. I have cameras and do background checks and she is spoiled with one on one care. I strongl believe we should take care of our parents because with this disease they want a hand to hold, someone close and are afraid but cant say it. I have interviewed many many cnas whom told me all about the nursing homes and how the have to walk away from then when they hold out their hand, the couldnt take it and do home care now. I sure wouldnt want to be alone if I was confused would you? I did use daycare when I worked fulltime, I know its ver hard, but it can be done if ou really want to. I guess I am old fashioned, yes stressed a lot man times, but its just how I feel, we are all different. Take care.
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Hi reverseroles. Sadly many people can't keep parents at home. Especially with Alzheimers, as they try to get out, stay up all night, can be a danger to themselves or others. Or, as in my own case, mother had mental problems which cause her to just be mean and critical. We could never live together. She is in assisted living, and when the time comes will be in a nursing home. It's such a case by case decision for every family. Another thing I'd like to share with all is that many people have the misconception that if they are private pay they will get better treatment than those on Medicaid. Not true. The caregivers don't know who is paying and who is government supported. Our society has changed. My grandparents were cared for at home until death, or in one case of dementia, until she needed to be watched 24 hrs a day. I cannot do it for my own mother, and do not expect it of my children. With couples both working these days, nobody is home to take care of the elderly, and even with big families, it is often an unfair situation with one child bearing the burden, while the others have excuses.
Most nursing homes try their best to provide good care for everyone, but the direct caregivers (nurses' aides) are not well educated, or well paid for the difficult job they do. I applaud those who do it with love and kindness.
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Thats just so sad is digsusting, Awful! I would go get her home right away and keep her there with help. Oh dear, poor thing!
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Also----if the situation continues, and you are unable to move your mother to another facility, and feel you have received no satisfaction or improvement in her safety, there is another avenue. When the facility has its annual survey, be sure to approach a surveyor and ask if you can speak with them privately. Let them know your concerns. I am assuming you checked out the public records on the facility before your mother was admitted, and results of previous state surveys are available online.
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I am so sorry that happened, but definitely the nursing home is responsible party. I am a retired nursing home administrator. They have a legal responsibility to keep your parent safe. Their investigation should include many things, and conclude with a plan of action, stating what they intend to do to prevent this from happening again. It may be that the aggressor's meds need to be changed; it may be that a room change is a good idea to keep them apart; or it may simply conclude that this was unavoidable and unpredictable, and they will provide better supervision. That said, it's a very difficult situation when you are dealing with dementia. Nobody can know what set him off, or why she was the target.

You can file a complaint with the state; if you have an ombudsman office in your state, call and file a complaint with their office. It's true the facility cannot control every resident at every moment and these things do happen unfortunately, but it needs to be thoroughly investigated. Did the other patient have a history of this behavior? in which case, they should have been watching him more carefully. If this is the first time he has acted out, there may be nothing to be done, as they couldn't have predicted it. Unless there was lack of supervision, and no facility can afford one-on-one care, it is unlikely anyone is going to pursue this legally. You don't want to be a thorn in the side of people who need to be your allies, but it pays to be a strong advocate for your parent, and very assertive. Staff very quickly learn which residents have children that will insist on the best care. All residents deserve the best care, but in nursing homes and in life, the squeaky wheel gets greased. Believe me, it makes a difference.

I loved my job, but dealing with situations such as this are very stressful on everyone. So happy to be retired. (Now I only deal with one elderly person, Mom, and that is challenging enough!)
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I am so sorry about your mom. You seem to be a very kind and loving daughter. I can tell by your post. Do you like the Nursing Home? Unfortunately, because the government will only reimburse them for so many people being on duty at one time, they often go understaffed. My mom was in one of the best nursing homes that I could ever find, however they were so understaffed that she feel one day and was taken to the hospital. Her roommate told me that she had been on the floor without her oxygen for a long time. She said she was pushing the call button but no one ever came so she said she started to yell as loud as she could. She was such a sweet sweet lady and was very concerned about my mom. I was so torn because I really liked the nursing home and it was just beautiful. She did return to the nursing home because my thoughts were that they all are so understaffed because of the way the government reimburses them. I remember I had asked the occupational therapist if she would see my mom a little longer and she said she couldn't because they were only allowed so many minutes with her because that was all that Medicare allowed. If I were you and you think that you are going to keep her there, I would tell them EXACTLY WHAT YOU WROTE. You won't tolerate it ever again, you want to know what they plan on doing to protect your mom from this happening again, and you did not appreciate the "non concerned" attitudes that you received already. If you have any red flags about the nursing home (other than this huge one) I would start to look for another one. There are some WONDERFUL ones out there (not perfect) but as perfect as the government will allow them to be. May I also suggest that you hire someone to look in on your mom or ask friends or other family members to drop by as often as you can. There are wonderful mommy's out there who need something to do while there children are in school and would love to earn a little money and peek in on your mom. Just a thought. I just lost my mom not too long ago and I miss her dearly. You are a wonderful daughter and a very caring one too! I can just tell in your post, you are angry but you aren't using hateful words. God Bless you for not putting blame on the man. Some nursing homes have to find new homes for people like him. It may be time that they did. Demand some answers. Maybe ask if your mom can be moved to a room that is located right in front of a nurses station? HUGS and LOVE to you!
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Definitely find out how the NH intends to deal with violent patients in the future. Report them to the relevant NH licensing authority AND the police. Assault is a criminal matter no matter where it occurs. I'm so sorry about your mother - that should never have happened.
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Every single word Veronica said...

I am so sorry that this happened to your mom. My heart goes out to you both. I understand that the elderly man really can't be blamed for his actions, but that facility damn sure should be, especially if the man has had violent episodes before. He should NEVER, ever been allowed to roam free after the FIRST time he got violent, period. All I can say, is I'd report them, and heads would roll.
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Unfortunately injuries, attacks, falls, accidents and abuse are not uncommon in N/H. It is due to minimally trained staff and too few of them. Such incidents as one patient attacking another at least in NYS are reported to the state and an investigation is begun, It can result in a temporary stop on admissions or the termination of the facilities license.
When you are requesting a patient's medical records be sure to include the nursing notes. This is in a separate section of the patients "chart" often just a folder and sometimes kept on computer. Every nurse on every shift must write a report on the patients assigned to him/her. They must document behavior eating, drinking activities sleeping refusal of care or medications. Anything unusual. A night nurse may simply write " Mrs X slept all night took her meds and walked to the B/R unaided and says she will get dressed when the day shift arrives." if any kind of incident occurred in her area the nurse would report her reaction . " She might note " Mrs X was very upset because her room mate fell this morning and was taken to the ER. She is very worried she will be assigned another room mate as she and Miss A have become good friends" The POA has the right to read those notes and they can be very illuminating. The N/H may be reluctant to comply.
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My heart aches for your Mom.. That is so sad. She must have been so frightened. I'm sure you'll feel better after she is moved to the new place.. Good luck and best wishes.
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TC12345, I find it very interesting that you posed this type of issue at this time. Oddly, something *Very* similar happened to my mother-in-law just about a month ago. The main differences were that it happened in a specialized memory-care assisted living facility (lock-down unit) instead of an NH; she has moderate-to-severe Alzheimer's (so she couldn't remember to give her account of what had happened), and the gentleman involved had hit her over the head -- evidently with his fist.

My husband and I were notified by the facility's medical personnel shortly afterward that evening that she was being taken to the hospital ER. As we live somewhat distantly from the ALF, and my husband was not reachable by phone at that exact time, I remember trying to find out more information about just what and how the altercation happened, but feeling somewhat frustrated in the process. The med tech declined to tell me the identity of the resident who had struck her (not that I knew the other facility residents by name, anyway); or what instigated the conflict. They volunteered little information and I got the impression that they were somewhat eager to get off the phone, like they were only discharging a legal obligation to inform us (as my MIL's DPOA/MPOAs) of the incident; and felt they had done what was required of them.

I called back a couple hours later for an update report, and another employee incidentally *Did* give me the gentleman's name -- I figured it couldn't hurt to ask. :). They assured me the ER visit was just a routine precaution (in the case of all head injuries); she had only stayed one hour (turned out later she had a CT scan); and was in fact on her way back to their facility via their own vehicle. We had expressed concerns about any associated hospital bills, since my MIL still owes medical bills from months prior (including three costly ambulance transport fees) that she (now on Medicaid) can't afford to pay; and we were not in financial position to cover for her. We were assured they were doing everything they could to economize (such as returning her in the facility van instead of the ambulance); and that her Medicare/Medicaid should take care of the rest.

A few days later we visited my MIL and admittedly her injury did not look serious at the time. It was a small oval scab, about no more than an inch or so in diameter on the left side of her temple. She also did not mention the incident or injury, or complain of any discomfort.

I'd politely requested the facility staff for any paperwork they had on the incident. We were given 5 pages of what appeared to be a standardized instructional sheet given out by the hospital in the wake of a head injury -- describing how to monitor for concussions, other necessary follow-up care, etc. There was very little personal information included, except for a "current" medications list which was incorrect (as some had in fact been discontinued weeks prior).

The on-duty med tech could not explain the discrepancy on the medications list; but was quick to insist that was the only paperwork the facility had on file pertaining to the accident, which I found odd. Stranger still, despite her (typically) busy schedule, she sat for several minutes at the table while I looked the papers over, I suppose under the pretense if I had any further questions; but it made it difficult for me to concentrate with her staring.

I was left curious what she wanted or expected from me. "These are our copies to keep, correct?" I asked. She said yes, and when I'd asked her about her own understanding of how the accident happened, she'd suggested that my MIL had occasioned it, as she'd "gotten up into the gentleman's face" and was making verbal advances towards him. Shortly afterwards the med tech was called away to help another employee, saying she would be back later (although she did not return).

We are curious why we were not told of my mother-in-law's part in the altercation until that time (days later). We are left wondering whether the facility might have concocted a story in the meantime to try and place the blame on her (and thus away from any potential lack of oversight); as she is by nature not a very social person and hasn't been known to be aggressive in that manner. In her present mindset, she mainly just wants to be left alone by other residents and/or allowed to "go home".

There are several reasons why we're still concerned about this incident. Not long before this happened, we were visiting the facility one evening when an older female resident had fallen and hit her head on the (carpeted) floor in a nearby hallway. My husband and I did not actually see her fall, but we heard the noise. The same med tech (that later talked to us about my MIL) was yelling at and arguing with a man seated along the other side of the hallway. We learned that he had pushed the poor woman roughly and she'd fallen from her walker; also this was not the first time that particular male resident had been aggressive toward others.

After the paramedics came and carried the woman to the ER, the med tech confided to me that if it were up to her, the male resident would be transferred out, as he (in her view) was a danger to other residents. "But I am not the one to make that call..." she added. Later, following our own unfortunate incident, she'd said that it was another resident (not the same person) who'd struck my mother-in-law. I only wish my recollection of names and faces was better, as I can't verify one way or the other at this time.

A second reason this is still an issue of concern: About two weeks after Mom was attacked, I was phoned by someone at the facility, who identified themselves as an employee of our state's regulatory department for residential care facilities. They asked me some general questions about my experiences with my mother-in-law's care; but for some odd reason seemed particularly interested in the identity of the employee who'd informed us which resident struck my mother-in-law. I told them I did not feel at liberty to disclose it; that the person had in fact done us a favor (we now knew who to keep an eye on/keep my MIL away from); and did not wish to get him or her in any kind of trouble. The caller accepted my explanation and asked no more about it; but I have since wondered what precipitated the contact call in the first place, and if the caller was truly who she claimed to be.

Thirdly, it has now been a month since the accident, and Mom's injury has shown little to no progress in healing. :( I need to follow up on that with the resident's visiting physician, also find out what they might know about how it happened. I would have sooner; but this particular PA doesn't return phone calls and no consultations (apparently) except in person at the time of exams.

What I would advise you to do, TC12345 (sorry for taking so long to get around to it) -- and what I wish I would've done sooner, in my own above situation, is to inquire with the treating physician and/or hospital and request your mother's medical records. Verify whether the information the nursing home representatives gave the medical professionals is the same one they told you. Also, if your mother made any statements to them while being treated, those should be summarized in writing, too, if my own experience (albeit brief) with hospital records is any indication.

You might also want to consult with your local nursing home ombudsman for your area and see if the facility where your mother resides has had any similar incidences or complaints filed. They can also tell you more about your rights and expectations from the nursing home as resident/family member in this situation; and what is "reasonable caution" they need to exercise to prevent this kind of thing from happening again.

Meanwhile, in our own situation, the first (thankfully small) medical bill has shown up from that night my mother-in-law visited the ER. Fortunately it was a clerical oversight of policy information not getting correctly relayed (according to the person I'd talked to about it). But the next one might not be; and I am concerned lest this type of thing become a regular occurrence.
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I would say that the NH is liable, but at the same time they have my sympathy. They are dealing with a situation that none of us have been able to figure out perfectly. They are unable to restrain, and even in locked units, residents encounter other people. Are they taking care that it doesn't happen again? If they are, maybe forgiving them would be the best thing. It can be hard to predict when a person with late dementia will go over the edge for a few minutes. Have they otherwise done a good job? Did they pay for any medical bills that resulted from the assault? I believe you have to weigh the goods and bads and make allowances for events that may happen when dealing with dementia. If your mother remains, I hope they can make sure it doesn't happen again.
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Your welcome good luck to you as well. I am glad your mother is going to be moving to a memory care unit.. Dementia is so heartbreaking anyways and then to have something as awful as that happen. Their safety is our top priority.
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Thank you for your input Sylvia. I am awaiting a transfer for my Mother to the nursing home my Father is in. They both went into separate nursing homes, one after the other this year after Father was diagnosed with Lewy Body Dementia. He went immediately into a lock down unit of a memory care facility where he is getting good care. Mother's alz deteriorated after that point and there was no room where he was so she was temporarilly assigned to this home while waiting for a spot in his. I don't want to move her twice so I just want her safe till her spot opens up with him.. You're right it is very hard with dementia. I am sure you will feel better when your Mom is where you want her to be. Good luck with the transfer next week, and thanks again.
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That makes me so sad for your mother. I am sorry. I don't have any official information to give you on the situation. I would probably move my mother if that is an option.. We have had my mother in a nursing home for a few months now and we are moving her next week to a memory care center. It's not that we felt they did anything wrong, its just that they are so understaffed and with dementia it is hard.. We feel that as she progresses she will be safer and better off in a memory care facility. Alot of staff at her nursing home now don't have alot of knowledge on dementia. Good luck and again I am so sorry this happened to your mother.
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