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My mom has been living in a skilled nursing facility for 2 years. Her new roommate for the last 4 months is somewhat non-verbal (she’s has a tracheostomy but screams her kids name at all hours of the day and night) At first she was a huge annoyance constantly banging on things, clapping, and screaming. She tries to get out of bed even though she is not allowed, pulling on her feeding tube and tracheostomy tube. Recently she has gotten worse, she throws and smears feces everywhere. She threw an orange at my mom and me because she was jealous that her kids were not there (or so the staff told me) it almost hit me, and just from it grazing me I could tell how hard she threw it. It could have really hurt my mom. Social services said they took her oranges away but she has them again (now that the health dept isn’t here doing there survey anymore) and yesterday she threw one at people walking in the hall. She grabbed my mom’s call light from her bed, and when the nurse returned it to my mom she viciously grabbed the cord. My mom asked her to stop and she tugged at it fiercely repeatedly and the look on her face was extremely distressing.


When told about their mother’s behavior the kids blame the facility saying if they had put her in a wheelchair she wouldn’t be violent. However she was in a wheelchair but she constantly got up and transferred herself between the chair and bed. I alerted nurses but there was an emergency down the hall. At one point she knocked her feeding stand into one of the nurses and it almost hit her. I’ve seen her shove CNA’s and grab at staff members clothes very aggressively.


The roommate exhibits signs of dementia. She’s becoming increasingly angry and aggressive, but the administrator’s seem to be afraid of this family. They keep saying there is nothing they can do because the law protects this woman and not the nursing home. Her kids are verbally abusive to the staff, and the daughter even tried to intimidate a lady down the hall who asked her to quiet her mother’s banging because her husband was sleeping.


I’ve now been approached by multiple family members of residents- they can hear her banging halfway across the building, they have told me the family are bullies. I’ve been approached by staff members who can’t take it anymore and say that this woman belongs in dementia care and that her behavior is psychologically abusive to my mom.


Social services only offered to move my mom to a different room, smaller and not next to a window because the roommate’s family refuses to move to another room. Everyone feels this is unfair, my mom likes her room and she is not the problem.


I was highly upset that social services tried to tell me that we all have to make sacrifices yet the roommate does not have to. I invented the word sacrifice. I quit my job and no work part time, and moved into a tiny room to be able to spend most of my time caring for my mom, to the advantage of the facility yet this other family is getting preferential treatment for being rude.


I’m going to talk to the head administrator tomorrow and will would love to have a better understanding of what our rights might be in this situation. I’m speaking on behalf of staff and other residents and family so I would greatly appreciate any advice you guys might have. Especially if there is legal grounds to evict this lady because I don’t believe they can care for her at this facility because of her mental issues. But her children are delusional and also refuse to have her medicated for anxiety. Thank you so much!

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Hanna,
What did you find out when you talked with the head administrator about your Mom's roommate's aggressive behavior?
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Reply to DeeAnna
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I wish you the very best luck in talking to the head administrator and hope you can find a solution to an intolerable situation. Looking at your last point first, I would doubt the children can refuse to have her medicated unless they have power of atorney for her. Re the dementia and where she is "homed" (sorry don't mean to make her sound like a dog) she really sounds as though whilst she may have dementia and it may be displaying as violent tendancies, she is actually a real mental illness patient and unfortunately needs to be in a facility where she could probably be sedated all the time. It is hard because it is not your relative but if the home will not have her moved to somewhere with mental health management of the type she is showing, then perhaps they should put her in a single room as far away from others a possible, because she is obviously a physical danger to other people never mind the psychological harm caused to them by the atmosphere and noise etc being caused.
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Reply to TaylorUK
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Just re-reading your description of the family members' bullying - if they so much as look cross-eyed at another resident, that's it - they should be out of the building without their feet touching the ground. If the senior member of staff on duty doesn't respond you could consider calling the police.
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Reply to Countrymouse
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This situation poses a risk to the resident herself, to your mother, to the staff. It also distresses and inconveniences the whole of the community.

Raise Cain. Find out what the formal complaints procedure is and get going on it.

Perhaps the family has already found it very difficult to secure a placement for their mother, and that is why they are being so bloody-minded and aggressive about keeping this one. If they are in denial about her level of dementia, this is not surprising. But the family's stupidity is not your problem: it is up to the Nursing Home, especially whoever conducted the pre-admission assessment, and the other resident's doctors to get to grips with it.

If the family is persistently aggressive or threatening towards the staff, they can be prevented from entering the premises. Do not allow the NH to wriggle out of anything because they're reluctant to confront unacceptable behaviours.
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Reply to Countrymouse
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Work together with the other families - form a group to get the roommate moved immediately to a different area (with a higher level of care)— or removed from the center as soon as possible. You will be more powerful as a group.

Hire a lawyer if you don’t get quick action.
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Reply to ACaringDaughter
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Wow, I would think there would be a precedent for the new person to be the one who moves is a situation like this when your mom has been there so much longer. But more importantly your talking about safety, your moms and the staffs. Most NH's I thunk have policy's about what they will and wont tolerate when it comes to disruptive and dangerous patients and it sure seems like they may require this roommate to move soon anyway. Maybe it's time for you to get more pushy like the family of this other resident, you can do it in a nice but firm way, insist the other woman be moved to the smaller room without a window, your mom has been there 2 years is it? My guess is the staff knows the difference between you getting difficult (protecting them as well as mom) and the family of this new resident so I wouldn't worry much about how you appear to them. I'm not sure if reporting this dangerous patient to whoever is paying for mom's care and or the local oversight of care facilities but you might even be helping the facility by doing that, maybe offer in a firm way that could be taken as threatening giving them a reason to move this other woman?
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Reply to Lymie61
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I would call the Ombudsman and run this by them. It is not fair that one resident is disrupting everything on the floor. That staff is being abused this is not exceptable.
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Reply to JoAnn29
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[2 of 2 postings]

https://www.caringfortheages.com/article/S1526-4114(08)60148-1/pdf 
“The Laws of Dealing With Difficult Residents And Families Can Be Difficult in Themselves”
 
Heading Off Problems”
 Although the court cases above involve residents harassing staff, a nursing home may also face legal consequences when a resident or a resident’s family member sues. In cases involving difficult residents and families, courts have typically focused on the particular nursing home’s policies and procedures. Besides having those items in order, a facility can take many other steps to make it more likely that its actions would be deemed appropriate by a court:  

--Post the policies on various forms of harassment in areas frequented by staff, provide the policies to temporary staff, and educate staff at least annually on such policies and procedures.  

--Address residents’ and family members’ behavior via proper care planning, which may involve behavioral interventions and monitoring.  

--Consider a “behavior contract” with a resident or a family member, in which the individual agrees in writing to abide by certain standards. Behavior contracts must be utilized only with residents and family members who can participate in setting the terms of the contract and appreciate their meaning. The contract also needs to comply with the state and federal requirements related to residents’ rights.  

--Provide a proper medical assessment of the resident to rule out medical processes that may be the source of resident’s hostile behavior, such as infection or chronic pain.  

--Intervene early by providing psychological and psychiatric care to residents when necessary.

--Consider involving two staff members when providing care to residents with hostile or inappropriate behavior.  

--Educate the staff regarding diagnoses, such as dementia, that may cause hostile behavior by a resident; resident or family stress related to adjustment to the nursing home setting; and how to deal with inappropriate resident or family behavior.  

--Define clear limits with residents and family members whose behaviors are escalating. Consider communicating such limits to family members in writing.

--Identify a specific staff member for family members to communicate with regularly. Creating a point person for family concerns streamlines efforts to address issues before they escalate to troublesome levels. A facility’s approach to dealing with difficult residents and families with preventative and proactive measures pays dividends in the long run.


[A nursing home that I worked in had a "behavioral contract" with a resident, and it did help decrease the frequency of the unwanted behavior.  However, I think that your Mom's roommate is dealing with a HUGE amount of ANGER and FRUSTRATION because of her health problems and because of her inability to communicate verbally. Think of a young child who cannot express his/hers needs--they have a temper tantrum.  I am wondering if much of the roommate's behavior is her way of expressing her frustration and anger.]

I hope that the information that I have shared can be the basis for your discussion with the nursing home administration.  You might want to "Google" the problem of "difficult nursing home resident" and see if you can find more suggestions that the nursing home staff or your Mom or you can use when dealing with such an angry and abusive person.  Good Luck.  {{{HUGS}}}
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Reply to DeeAnna
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Something like this happened to my mom. I wrote a detailed email to the SW and administrator and told them that my mother was being subjected to an unsafe and threatening environment. I asked them to inform me in writing what corrective action would be taken.

The disturbed roommate was moved the next morning.
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Reply to BarbBrooklyn
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Sometimes it is better to be safe and stress free rather than right - if it were me I would take the smaller room with a promise of a return to this room or another similar room as soon as possible.
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Reply to cwillie
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Write a letter to the facility senior management, Explain all that you have put here, Insist on a meeting with management to discuss how the facility is going to resolve this issue to for the health and protection of your Mom.

if you do not get satisfaction from this ... send a copy of this letter and another letter to the your State Department of Public Health..CC the facility.

Just keep going up the food chain till you rattle enough chains to get action.

Do not not just accept inaction on the say so of low level staff.
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Reply to Katiekate
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[1 of 2 postings]
HannaS,
I am so sorry that your Mom is having to deal with such an angry and abusive roommate.  Your Mom’s situation is very difficult for nursing home administration and staff to deal with because neither the abusive resident or her family are willing to knowledge that her behaviors are abusive and can cause harm to other residents, family members and facility staff. 

According to:
https://www.aarp.org/caregiving/financial-legal/info-2018/nursing-home-evictions-fd.html

The federal government is launching an effort to stop nursing homes from discharging residents illegally.
Discharges and evictions lead the list of complaints that state long-term care ombudsmen receive each year. In 2015, these advocates for nursing home residents received more than 9,000 such complaints.

In a memo to state officials, the Centers for Medicare and Medicaid Services (CMS), which oversees nursing homes, said it has begun an examination of this widespread problem and will explore ways to combat it.

States have the primary responsibility for policing the nation’s nursing homes, but state regulators have to at a minimum follow federal rules that list six (6) specific reasons a facility can legally evict a resident. A nursing home can force a resident to leave only if at least one of the following conditions is met:

--The resident’s clinical or behavioral status endangers the safety of others at the facility. The reason most often reported for patients’ being discharged against their will is “behavioral, mental and/or emotional expressions” of distress, CMS says.

--The resident’s care is not being paid for. This is another common reason for such forced discharges. This can happen when individuals who had been paying privately run out of resources and enroll in Medicaid, which reimburses nursing homes less than they receive from private-pay patients. It also happens when Medicare residents shift to being covered under Medicaid.

--Transfer or discharge is necessary for the resident’s welfare and the facility cannot meet his or her needs. The CMS memo notes that a nursing home should determine whether it can adequately care for an individual before that person is admitted. Once someone becomes a resident, the memo says, “it should be rare” for that facility to later say it cannot meet that individual’s needs.

--The resident no longer needs the services the nursing home provides.

--The resident’s continued presence endangers the health of others at the nursing home.

--The nursing home is closing.

Discharges that violate federal regulations “can be unsafe and/or traumatic for residents and their families,” the memo says, adding that nursing home residents are sometimes left homeless or hospitalized for months when they are evicted.

[I will continue with some suggestions that the nursing home can use when dealing with difficult residents and/or families. ]
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