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Conflicts between nursing home residents are often chalked up to dementia – the real problem is inadequate care and neglect

<p>Frank Piccolo was a beloved high school chemistry teacher in Ontario, Canada, until his retirement in 1998. “His trademark was to greet all of his students at the door at the start of class to make sure everyone felt welcomed there,” <a href="https://www.saultstar.com/2013/02/21/remembering-frank-piccolo--oconnor">wrote a former student</a>. “He had extensive knowledge of his subject matter, passion for his craft, and empathy for his students.”</p> <p>But after Frank’s retirement, he developed dementia. When his condition declined, his family moved him to a Toronto nursing home. One evening in 2012, another resident – a woman with dementia – entered Frank’s bedroom. She hit Frank repeatedly in the head and face with a wooden activity board. Staff found Frank slumped over in his wheelchair, drenched in blood. He died three months later.</p> <p>The Ontario Ministry of Health and Long-Term Care investigated. It found that the woman had a history of pushing, hitting and throwing objects at staff and other residents. But the nursing home didn’t address the woman’s behavioral expressions for weeks before the attack on Piccolo, <a href="https://s3.documentcloud.org/documents/21048374/inspection-report.pdf">the agency determined</a>. “There were no interventions implemented, no strategies developed,” the report stated.</p> <p><img src="https://images.theconversation.com/files/440940/original/file-20220115-27-vtyb52.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=237&amp;fit=clip" alt="Frank Piccolo and his wife, Theresa, standing near each othe, on vacation, with a hillside village and the sea behind them." /> <span class="caption">Frank Piccolo and his wife, Theresa, traveling together in Italy in 2001.</span> <span class="attribution"><span class="source">Theresa Piccolo</span>, <a href="http://creativecommons.org/licenses/by-nc-nd/4.0/" class="license">CC BY-NC-ND</a></span></p> <p>As a gerontologist and <a href="http://dementiabehaviorconsulting.com">dementia behavior specialist</a>, I’ve <a href="https://www.healthpropress.com/product/understanding-and-preventing-harmful-interactions-between-residents-with-dementia/">written a book</a> on preventing these incidents. I also co-directed, with dementia care expert Judy Berry, a documentary on the phenomenon called “<a href="https://terranova.org/film-catalog/fighting-for-dignity-a-film-on-injurious-and-fatal-resident-to-resident-incidents-in-long-term-care-home">Fighting for Dignity</a>.” The film sheds light on the emotional trauma experienced by family members of residents harmed during these episodes in U.S. long-term care homes.</p> <h2>Reporting and stigmatizing</h2> <p><a href="https://doi.org/10.1111/j.1532-5415.2008.01808.x">Resident-to-resident incidents</a> are defined by researchers as “negative, aggressive and intrusive verbal, physical, material and sexual interactions between residents” that can cause “psychological distress and physical harm in the recipient.”</p> <p>These incidents <a href="https://doi.org/10.7326/M15-1209">are prevalent</a> in U.S. nursing homes. But they are <a href="https://www.statnews.com/2021/11/29/resident-to-resident-incidents-hidden-source-nursing-home-harm/">largely overlooked</a> by the Centers for Medicare and Medicaid Services, the federal agency overseeing care in approximately 15,000 nursing homes across the country. Consequently, such incidents <a href="https://doi.org/10.1080/08946566.2017.1333939">remain untracked</a>, <a href="https://doi.org/10.1016/j.jamda.2015.10.003">understudied</a> and largely unaddressed.</p> <p><a href="https://images.theconversation.com/files/440941/original/file-20220115-18-1qy7een.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=1000&amp;fit=clip"><img src="https://images.theconversation.com/files/440941/original/file-20220115-18-1qy7een.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=237&amp;fit=clip" alt="An elderly man with severe injuries, including cut marks and bruises, across his face and forehead." /></a> <span class="caption">Frank Piccolo sustained severe injuries to his face and head after a woman with dementia entered his bedroom and hit him repeatedly with an activity board.</span> <span class="attribution"><span class="source">Theresa Piccolo</span>, <a href="http://creativecommons.org/licenses/by-nc-nd/4.0/" class="license">CC BY-NC-ND</a></span></p> <p>These interactions don’t just result <a href="https://doi.org/10.1001/jama.291.5.591">in injuries</a> <a href="https://doi.org/10.1177/0733464819863926">and deaths</a> among residents. They also leave behind devastated families who then must <a href="https://www.washingtonpost.com/business/2021/08/20/nursing-home-immunity-covid-lawsuits">fight for answers</a> and accountability from nursing homes.</p> <p>Making matters worse, <a href="https://www.gao.gov/products/gao-19-433">government reports</a>, <a href="https://doi.org/10.1017/S0714980815000094">research studies</a> and <a href="https://doi.org/10.1177/1471301220981232">media coverage</a> commonly describe these episodes with words that stigmatize people with dementia. Researchers, public officials and journalists tend to <a href="https://www.startribune.com/when-senior-home-residents-are-abusers-minnesota-rarely-investigates/450625693/">label the incidents as “abuse</a>,” “violence” and “aggression.” They call a resident involved in an incident a “perpetrator” or an “aggressor.” News outlets described the attack on Piccolo by the woman with dementia as “aggressive” or “violent.” And when reporting on <a href="https://www.thestar.com/news/gta/2013/02/09/more_than_10000_canadians_abused_annually_by_fellow_nursing_home_residents.html">the phenomenon</a> in Canada, the Toronto Star called it “abuse.”</p> <h2>Getting to the root of the real problem</h2> <p>Most incidents, however, do not constitute abuse. A growing body of evidence suggests the true cause of these injuries and deaths is inadequate care and neglect on the part of care homes. Specifically, there is a lack of the specialized care that people with dementia require.</p> <p>Two of every three residents <a href="https://doi.org/10.1016/j.jamda.2021.02.009">involved in these incidents</a> have dementia. One study found that the rate of these episodes was nearly <a href="https://doi.org/10.1001/jama.291.5.591">three times higher</a> in dementia care homes than in other long-term care homes. A recent study also found <a href="https://doi.org/10.7326/m15-1209">an association</a> between residency in a dementia care home and higher rates of injurious or fatal interactions between residents.</p> <p>But for these residents, the conflicts occur mostly when their emotional, medical and other needs are not met. When they reach a breaking point in frustration related to the unmet need, they may push or hit another resident. My research in the U.S. and Canada has shown that <a href="https://doi.org/10.1080/08946566.2018.1474515">“push-fall” episodes</a> constitute nearly half of fatal incidents.</p> <p>Another U.S. study found that as residents’ cognitive functioning declined, they faced <a href="https://doi.org/10.1001/jama.291.5.591">a greater likelihood</a> of injury in these incidents. Those with advanced dementia were more susceptible to inadvertently “getting in harm’s way,” by saying or doing things that trigger angry reactions in other residents.</p> <p>The Centers for Disease Control and Prevention has stated that what it calls “aggression” between residents <a href="https://www.cdc.gov/violenceprevention/pdf/ea_book_revised_2016.pdf">is not abuse</a>. Instead, the CDC noted that these episodes may result when care homes fail to prevent them by taking adequate action. And a study on <a href="https://doi.org/10.1177/0733464819863926">fatal incidents</a> in U.S. nursing homes has shown that many residents were “deemed to lack cognitive capacity to be held accountable for their actions.”</p> <p><iframe width="440" height="260" src="https://www.youtube.com/embed/gk5iEo-s_6M?wmode=transparent&amp;start=0" frameborder="0" allowfullscreen=""></iframe> <span class="caption">An undercover yearlong investigation into nursing homes in Ontario, Canada, revealed shocking instances of abuse and neglect by staff members.</span></p> <h2>How incidents often occur</h2> <p>In one study, researchers examined <a href="https://doi.org/10.1177/1054773813477128">situational triggers</a> among residents with cognitive impairments. The strongest triggers involved personal space and possessions. Examples include taking or touching a resident’s belongings or food, or unwanted entries into their bedroom or bathroom. The most prevalent triggering event was someone being too close to a resident’s body.</p> <p>That study also found that crowded spaces and interpersonal stressors, such as two residents claiming the same dining room seat, could lead to these episodes. <a href="https://doi.org/10.1177/1471301213502588">My own work</a> and a different <a href="https://doi.org/10.1177%2F0733464820955089">Canadian study</a> came to similar conclusions.</p> <p>Other research shows that when residents are bored or lack <a href="https://doi.org/10.1177%2F153331750502000210">meaningful activity</a>, they become involved in <a href="https://doi.org/10.1177%2F1471301213502588">harmful interactions</a>. Evenings and weekends can be particularly dangerous, with fewer organized activities and fewer staff members and managers present. <a href="https://doi.org/10.1080/08946566.2018.1474515">Conflicts between roommates</a> are also common and harmful.</p> <p><img src="https://images.theconversation.com/files/438566/original/file-20211220-49721-z6ev8m.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;fit=clip" alt="With a smiling staff member looking on, two nursing home residents enjoy conversation while having coffee." /> <span class="caption">Residents with dementia who are meaningfully engaged in activities are less likely to become involved in harmful incidents with other residents.</span> <span class="attribution"><a href="https://www.gettyimages.com/detail/photo/caretaker-with-senior-people-in-nursing-home-royalty-free-image/489582967?adppopup=true" class="source">Morsa Images/DigitalVision via Getty Images</a></span></p> <p>A growing body of research suggests that most incidents between residents are preventable. A major risk factor, for example, is lack of adequate supervision, which often occurs when staff are assigned to caring for too many residents with dementia. One U.S. study found that <a href="https://doi.org/10.7326/M15-1209">higher caseloads</a> among nurses’ aides were associated with higher incident rates.</p> <p>And with <a href="https://doi.org/10.4137/hsi.s38994">poor staffing levels</a> in up to half of U.S. nursing homes, <a href="https://doi.org/10.1080/08946566.2018.1474515">staff members do not witness</a> many incidents. In fact, one study found that staff members missed the majority of unwanted <a href="https://doi.org/10.1080/13607863.2016.1211620">bedroom entries</a> by residents with severe dementia.</p> <h2>Residents with dementia are not to blame</h2> <p>In most of these situations, the person with dementia does not intend to injure or kill another resident. Individuals with dementia live with a serious cognitive disability. And they often must do it while being forced to share small living spaces with many other residents.</p> <p>Their behavioral expressions are often attempts to cope with frustrating and frightening situations in their social and physical environments. They are typically the result of unmet human needs paired with cognitive processing limitations.</p> <p>Understanding the role of dementia is important. But seeing a resident’s brain disease as the main cause of incidents is inaccurate and unhelpful. That view ignores external factors that can lead to these incidents but are outside of the residents’ control.</p> <p>Frank’s wife, Theresa, didn’t blame the woman who injured her husband or the staff. She blamed the for-profit company operating the nursing home. Despite its revenue of $2 billion in the year before the incident, it failed in its “<a href="https://www.thestar.com/news/gta/2013/02/09/more_than_10000_canadians_abused_annually_by_fellow_nursing_home_residents.html">duty to protect</a>” Piccolo. “They did not keep my husband safe as they are required to do,” she said.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important; text-shadow: none !important;" src="https://counter.theconversation.com/content/173750/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><span><a href="https://theconversation.com/profiles/eilon-caspi-1298265">Eilon Caspi</a>, Assistant Research Professor of Health, Intervention, and Policy, <em><a href="https://theconversation.com/institutions/university-of-connecticut-1342">University of Connecticut</a></em></span></p> <p>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/conflicts-between-nursing-home-residents-are-often-chalked-up-to-dementia-the-real-problem-is-inadequate-care-and-neglect-173750">original article</a>.</p> <p><em>Image: CasarsaGuru/E+ via Getty Images</em></p>

Retirement Life

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Mum hits back at neighbour over chalk complaint

<p><span style="font-weight: 400;">A New York mum and author who received complaints from a neighbour over her son’s chalk drawings in their apartment block’s courtyard has responded with a public letter - and it’s written in chalk.</span></p> <p><span style="font-weight: 400;">Ashley Woodfolk then shared her letter on Twitter, receiving a flood of positive responses.</span></p> <p><span style="font-weight: 400;">“GOOD EVENING TO EVERYONE EXCEPT the woman at my co-op who complained to the board about me and my toddler using sidewalk chalk in the courtyard,” Ashley Woodfold captioned the photo of her handiwork.</span></p> <p><span style="font-weight: 400;">The letter, written in blue and yellow chalk, reads: “This will be the last time using sidewalk chalk in the courtyard since it seems to be such a problem for you (and only you).</span></p> <blockquote class="twitter-tweet"> <p dir="ltr">GOOD EVENING TO EVERYONE EXCEPT the woman at my co-op who complained to the board about me and my toddler using sidewalk chalk in the courtyard.<br /><br />So I wrote her a little letter. <br />In sidewalk chalk. In the courtyard. <a href="https://t.co/Tbw52ZtVV1">pic.twitter.com/Tbw52ZtVV1</a></p> — Ashley Woodfolk (@AshWrites) <a href="https://twitter.com/AshWrites/status/1452812801651757056?ref_src=twsrc%5Etfw">October 26, 2021</a></blockquote> <p><span style="font-weight: 400;">“I’m sorry harmless fun that brought my toddler joy (and has actually helped him learn all of his letters and most of his numbers - his favourites are E and 8) causes you so much distress that you had to complain to the board and waste everyone’s time when our building has so much bigger real problems.”</span></p> <p><span style="font-weight: 400;">Ms Woodfolk also detailed how the COVID-19 pandemic had seen her have to entertain her son in new, safe ways.</span></p> <p><span style="font-weight: 400;">“I think you’re aware that we’re in a pandemic and while I’d love to take my kid to museums and the movies I don’t feel safe doing that, and sometimes even local parks are more crowded than I’m comfortable with,” she continued.</span></p> <p><span style="font-weight: 400;">“The courtyard was a safe space but now there are limits on that too.</span></p> <p><span style="font-weight: 400;">“There are only a few weeks of nice weather left, and I sincerely hope that you enjoy the use of the sidewalk-chalk free courtyard for the remainder of the fall.</span></p> <p><span style="font-weight: 400;">“And I hope that every time it rains, rain that would have washed away any colourful ABCs I wrote on the ground, you think of me. All my love, Ashley.”</span></p> <p><span style="font-weight: 400;">Her post has received more than 200,000 likes, as well as a flood of positive comments.</span></p> <p><span style="font-weight: 400;">One fan even sent her a package of sidewalk chalk from their Etsy shop for her son.</span></p> <blockquote class="twitter-tweet"> <p dir="ltr">I own a small business making sidewalk chalk in all sorts of fun shapes and colors. I would love to donate chalk to you and your son ❤️ please check your DM’s! <a href="https://t.co/2MoQzpxIHX">pic.twitter.com/2MoQzpxIHX</a></p> — Amy ✨ (@alj_jayhawk) <a href="https://twitter.com/alj_jayhawk/status/1453114023868833794?ref_src=twsrc%5Etfw">October 26, 2021</a></blockquote> <p><span style="font-weight: 400;">Others shared their opinions and the enjoyment they received from seeing kids’ chalk drawings.</span></p> <p><span style="font-weight: 400;">“An elderly lady in our neighbourhood bought chalk for all the kids during the pandemic because she said she felt less lonely taking walks and seeing their art,” one person </span><a rel="noopener" href="https://honey.nine.com.au/parenting/author-ashley-woodfolk-writes-epic-courtyard-letter-to-neighbour-who-complained-about-her-childs-drawings/342b88f6-5acd-4eae-8019-5a87c6821ccf" target="_blank"><span style="font-weight: 400;">shared</span></a><span style="font-weight: 400;">.</span></p> <p><span style="font-weight: 400;">“As a childless guy, even I think chalk doodles are cute and bring a spark of life and creativity to the environment,” a second person said. “I can’t fathom how someone could be upset about it.”</span></p> <p><em><span style="font-weight: 400;">Image: @AshWrites / Twitter</span></em></p>

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Angry neighbour rants over chalk drawings

<p>A Melbourne resident tried to spread joy to her community by drawing on footpaths in chalk, but has since been labelled a "pretentious pr**k" by one of her neighbours.</p> <p>Fiona Cracknell set up Cracknell Chalk Drawings to showcase her chalk designs on Facebook.</p> <p>“I started drawing for my beautiful 3 year old daughter, had no idea it would impact my local neighbourhood while in lockdown this much,” Ms Cracknell wrote on the page.</p> <p>However, another resident took issue with the drawings and has since complained to council.</p> <p>“Someone has complained to the Council about my chalk drawing. Calling me a pretentious p**ck and that I am graffitiing,” Ms Cracknell wrote on the Facebook page on Thursday.</p> <p>“First of all I was doing to bringing joy to the community [sic], not cause drama and second, the Coucil loves it. For the first time in ages I have brought positive news to Gladstone Park.</p> <p>“I cannot believe this! I am really upset and angry. All I wanted was to make people smile at a time they needed it the most.”</p> <p><iframe src="https://www.facebook.com/plugins/video.php?height=314&amp;href=https%3A%2F%2Fwww.facebook.com%2F9NewsMelbourne%2Fvideos%2F266144354828037%2F&amp;show_text=false&amp;width=560" width="560" height="314" style="border: none; overflow: hidden;" scrolling="no" frameborder="0" allowtransparency="true" allow="encrypted-media" allowfullscreen="true"></iframe></p> <p>The letter was sent in anonymously and called the artwork "destructive graffiti".</p> <p>“I’ve copied the letter to the pretentious p**cks at that house in the hope they will see this letter as a warning and cease their crap,” the letter says.</p> <p>“They may also get it into their skulls that graffiti of council land is illegal. Placing the lives of locals at risk because of their desire to.”</p> <p>However, the council won't be doing anything, according to a statement from <em>7News.</em></p> <p>“Chalk messages and drawings on streets have been developed by children and adults alike during the COVID-19 pandemic, bringing hope and joy to Victorians during this difficult time,” the statement to Seven News said.</p> <p>“Council will not issue any fines for these drawings or ask for them to be removed.”</p>

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