State looking to end Alzhiemer Units
Posted by Patti on November 6th, 2006 / 
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Does working with people with Alzheimer’s Disease present a risk? And are they a risk to other residents?
Answer to both questions is YES.
Some Iowa nursing home operators, concerned about assaults on workers and residents, are considering the elimination of services for seniors with Alzheimer’s disease.There are currently 68,000 Iowans with Alzheimer’s disease. Not all of them are physically combative, but those who are often wind up in nursing homes alongside other vulnerable seniors.
It’s not Iowa’s problem alone. Every state deals with the same issue.
Two Des Moines-area nursing homes are now facing state fines for allegedly failing to protect residents from repeated physical attacks by seniors with dementia.Industry officials say such attacks are part of a growing problem. Steve Ackerson of the Iowa Health Care Association, a nursing home trade group, said some Iowa nursing home owners are now discussing eliminating special units for seniors with dementia and Alzheimer’s disease.
Because the risks of serious injury- to both staff and other residents- is very high within these specialized units. Many nursing homes have such units, and they are often in a locked location of the building. Staffing isn’t always the answer. Special activities are not always the answer either. Combative residents have no control over themselves and they live in a world that is not the least bit reality based. It’s a scary place to be, I’m sure.
Ackerson says the owners are concerned with the cost of those units and with the risk employees face in reacting to threats of violence. When state officials determine a caregiver has committed abuse in responding to an attack, the worker is banned from continuing to work with the elderly – effectively ending the person’s career.“It’s just scary,” Ackerson said. “And it’s hard for us to have a high number of people with dementia in our buildings because we’re just not reimbursed by the government for one-on-one care.”
The natural human reaction to being hit is to hit back. Often we can see it coming and can control our natural instincts. But when one doesn’t see it coming, one will react to protect themselves. This comes in the form of pushing the attacker away or down. When it happens in my line of work, it’s called abuse. I don’t characterize it that though, not at all. A violent demented resident will continue to beat up a staff (or a visitor or anyone else) who they perceive to be a threat. I know aides who have head injuries and broken bones due to an attack.
The discussion of eliminating Alzheimer’s units comes at a time when more seniors with dementia are in nursing homes. Nationally, the percentage of residents with a psychiatric diagnosis has increased 43 percent in the past six years.Experts cite several reasons for the increase: People are living longer, and the likelihood of developing Alzheimer’s disease doubles every five years beyond the age of 65. And, many seniors are staying healthy longer, which means they can remain in their own homes.
In 15 years they predict 20 million Americans will be dx with AD. That is a lot of people.
There have been incidents in Iowa that illustrate the problems care centers face:- Trinity Center at Luther Park, a Des Moines care center, was recently cited by the state for a series of incidents early this year. Over a period of several weeks, a resident of the home allegedly kicked a nurse aide in the back, punched a fellow male resident in the abdomen, threw one resident to the floor, struck a female resident in the face, and attempted to choke another male resident. He also is alleged to have knocked down one resident, breaking the man’s hip.
They can be violent as hell. It’s scary to work with those who cannot be reasoned with, who cannot control themselves in any manner. I can’t blame their families for not being able to handle this- that is where the violence begins- at home. People with Alzheimer’s will attack their spouses and children, siblings- it doesn’t matter. Whoever appears to be a threat. It’s a stage they go through, many of them, and it lasts for years.
In one instance, the man allegedly grabbed a nurse by the head and began punching and hitting the worker, saying, “I’m going to kill you.” Three Des Moines police officers were called to the scene.The resident was transferred from Trinity Center in April, but administrators at the home allegedly failed to report the assaults to state regulators. The incidents were uncovered during the home’s recent annual licensure inspection. Administrators offered no explanation of why they had not reported the assaults, inspectors said.
- Trinity Center is also contesting allegations that it attempted to cover up a separate assault in 2004 on one resident by altering some of its records. The state alleged that a male resident entered the room of an elderly woman with Alzheimer’s disease and beat her, leaving her bruised, bloodied and screaming for help.
A security camera in a hallway showed the man, who had a history of physical violence, entering the woman’s room and spending about 12 minutes there. The videotape shows the man leaving the room and then the woman emerging with blood on her face and yelling for help.
My question is: We know these residents to be so violent…what to do about it? Short of restraining them and drugging them, which is a violation in it’s own right, what is a facility supposed to do with the people? I don’t blame facilities for having a second look at whether to house violent demented patients and residents. It’s a huge risk- for all involved. People with Alzheimer’s disease eventually stop the violent behaviors, but at what cost? Some are not strong enough and mobile enough to do much damage, but others can really hurt staff and visitors.
What is the solution?
November 6th, 2006 at 11:18 pm
I simply do not understand why the state does not sanction violent patient take down training or at least endorse the use of such tactics by those they have received this training at their or a facility’s expense for special units in a nursing home. They do not have problem for its use in mental hospitals.
Allowing a violent patient to continue to beat another patient and not do everything possible to take control of the situation and stop the assault for the fear that the amount of force that has be used would be considered abuse of the violent patient is absurd. What the heck do you do in this horrible catch 22? Stop the assault which may include taking them down and physically restaining them until a nurse can get an order for futher intervention and run the risk of losing your license or not stop it and allow the patient just to whoop up on whomever he or she pleases and lose your license.
The states need to get a reality check before they set unrealistic and oftentimes dangerous bounderies.
November 8th, 2006 at 11:09 am
I think that even with enough “Staff” there will be injuries. The rates aren’t going to change; and I feel bad for the families of AD- because if enough facilities decide to not admit them they will have no alternatives…and keeping these people at home can be dangerous too.
November 8th, 2006 at 8:57 pm
Even if there are injuries it cannot be argued that they would not decrease with adequately trained and empowered staff. I think that rates would indeed change. The way it is now has not been proven to work for the very reasons I mentioned above. Alleviates these problems and the injuries will subside.
Alzheimer care is what I cut my teeth on when I became a CNA, and I have seen the product of a over zealous and know-it-all state. Back when there was less state intervention and witch hunts there was less injuries. In 1994 we did not have a single injury the year I worked the Alzeimer unit, because the nurses and nurse aides were more proactive in preventing and intervening in such events. These days we are afraid to expel gas crooked.
November 9th, 2006 at 1:45 am
These AD patients get booted out of the nursing homes and chucked into psych hospitals. They are brought in to get their meds adjusted and then the nursing home they came from refuses to take them back.
I work in psych and I can tell you this: we have never put an AD patient in restraints and we avoid taking them down unless it is an absolute necessity. They don’t understand what you’re doing to them. It makes them even more afraid and, hence, more violent… if they get bad enough, they get a “cocktail” adminstered IM.
We monitor these people constantly and look for signs that tell us if the patient is getting worked up and we will work with them until they can be redirected. Nursing homes can’t always do this… it requires alot of time out of a nursing home’s staff that is overflowing with duties and, most likely, understaffed.
We are trained to deal with these situations and know how to react without hurting the patient (as well knowing when to back off and — as I actually had to do once — run like hell!)
These patients need a psych hospital/nursing home hybrid… it seems these folks respresent a big black hole in healthcare. A whole facility, not just a unit somewhere, is needed to fill that gap. They just need a place they can go to get through that violent stage safely, with specially trained staff that monitor constantly (they are aware of where each patient is and what they are doing at all times).
I know they are dangerous, but they can’t help it and my heart aches for them.
November 9th, 2006 at 5:39 am
Thanks, Ajaxkid, for your info about how psych handles this problem. I would like to address a few of your points, though. I agree that mechanical restraints would be useless against AD pts as they would not understand the guidelines needed to be released and escalation is almost always the result. I cannot but feel that physical restraint which I believe usually accompanies a takedown would be needed if only in the most dangerous incidents. Our job is to not only provide for the safety of the AD resident, but the other pts, staff and visitors as well.
Preventive measures such as redirection and encouragement of delusions are all fine and dandy, but when an assault is taking place it must be stopped but fast. It is sad that they do not understand what is happening to them, but this simply cannot be an excuse not to act the proverbial poop hits the fan. I understand that this is probably not what you are saying.
November 9th, 2006 at 10:55 am
You are dead-on, Kevinicity. You gotta do what you gotta do and not be afraid to do it. If a patient has got his hands around another patient’s neck, you can’t stand there hands at-sides. But my point being, we have the advantage of constant monitoring to stop a patient before they even get to that point… nursing homes can’t do that. That’s a shame.
November 9th, 2006 at 8:29 pm
If I saw a resident going after another resident, damned straight I would intervene. I couldn’t turn my back. Write me up, bosses!
November 9th, 2006 at 8:31 pm
My heart aches for AD residents too. It’s such a horrible disease; these people would be mortified if they knew…and I have told everyone in my life IF I ever get DX with AD, once I start to lose it, TAKE ME OUT BACK AND SHOOT ME. I don’t want to live like that- it’s the only disease I feel that death would be better.