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A common assumption is that residents in nursing homes automatically get along with each other and live harmoniously for the remainder of their natural lives. Unfortunately, this is not a reality.

One of the most prevalent issues affecting residents in nursing homes is resident to resident abuse. Although this may be abuse that does not immediately come to mind when one thinks of abuse, it is all too common in nursing homes.

This article covers what constitutes resident on resident assaults, the nursing home’s obligations and what you can do if this happens to your loved one.

What is resident to resident assault?

The National Consumer Voice for Long-Term Care conducted a study on resident to resident assault in nursing homes and defined it in this way:

“Negative physical, sexual, or verbal interactions between long-term care residents that in

a community setting would likely be construed as unwelcome and have high potential to cause physical or psychological distress in the recipient.”

The following are common examples of resident to resident abusive behavior:

  • Verbal abuse (cursing or swearing, screaming, verbal threats);
  • Physical abuse (hitting, kicking, biting, scratching);
  • Sexual abuse (unwelcome verbal sexual advances, exposing self, touching/kissing/trying to get into bed);
  • Other abusive incidents (throwing items, destroying property, threatening gestures)

Why do these assaults happen?

Nursing homes house residents that typically have impaired cognitive ability or a mood disorder, which may impact their propensity for violence towards others.

Due to impaired cognitive ability or a mood disorder, new residents at nursing home facilities might have a hard time adjusting to their new surroundings.

Acting out, which may manifest in violence towards others, is very common.

It is the responsibility of the facility to identify any abusive or dangerous tendencies in its residents, and put care plans in place to avoid resident to resident assault.

Is the nursing home responsible for resident to resident assaults?

Yes, federal law requires nursing homes to protect its residents from abuse, including abuse from other residents.

Therefore, it is the nursing home’s responsibility to make sure that it takes the proper steps to ensure the safety of each resident.

What can a nursing home do to prevent resident to resident assault?

Resident to resident assault can occur in any nursing home setting.

However, nursing homes that are understaffed, crowded facilities, and nursing homes that consider resident to resident assault “normal” are more likely to have resident to resident assault occurrences.

The nursing home must complete a thorough initial assessment when a resident is admitted to the facility. Key questions that they should as are:

  • Does the resident have a documented history of violence towards others?
  • Due to health conditions, does the resident yell out?
  • If yes, is that typically towards another person in a threatening manner, or is it general yelling due to a medical condition?

The nursing home must answer these questions and thoroughly assess whether or not the resident might be violent towards other residents.

If the resident has a known history of violence, the nursing home must accommodate that resident so that he or she does not abuse or harm the other nursing home residents.

If a nursing home identifies that a resident has a propensity of violence towards other residents at the nursing home, the facility should do the following to help prevent resident to resident abuse:

  • Develop an individualized, resident centered care plan
  • Closely monitor residents that show a propensity of violence
  • Identify the risk factors that may trigger the resident to act violently
  • Provide adequate staff to resident ratios
  • Provide proper training for staff
  • Provide more meaningful activities and engagement for residents
  • Don’t allow common areas to become too crowded

Will my loved one report the abuse from another resident?

Resident to resident abuse is similar to victims of domestic violence or other kinds of abuse — often the victim is reluctant to report their abuse.

It’s also important to remember that in a nursing home setting, the resident may not cognitively be able to articulate the abuse to a staff member or family member.

The following are common symptoms to look for in a loved one if you suspect resident to resident abuse:

  • Behavioral changes. An increase in anxiety, changes in sleep patterns, changes in appetite and the like should be documented by nursing home staff members. Sometimes this can be a result in advanced stages of dementia, but it could also be the result of abuse against your loved one.
  • Unexplained bruising or abrasions. Injuries of any kind should have reasonable documentation explaining how it occurred.
  • Sexually transmitted diseases. Typically residents in nursing homes do not have the capacity to consent and must be protected from other residents
  • Withdrawal from social activities and family visits/caregivers refusing access loved one. Red flags should be raised if a loved one does not want to visit with family or a caregiver does not give a family member access to their loved one, whatever the reason might be.
  • Frequent injuries. Even if injuries are documented, one should be suspicious if injuries are happening frequently.
  • Broken personal items. If your loved ones personal items are being damaged, it may be a sign of a resident harming or intimidating your loved one.

It is important to report any suspected abuse in which your loved one may have been the victim. The nursing home is required to investigate all allegations of abuse.

How can nursing homes be held liable for resident to resident assault?

Nursing homes are required by law to protect residents from abuse, whether that abuse is from staff members or other residents. If the nursing home does not take the proper action and precaution to protect residents from other residents, then the nursing home can be held liable for injuries suffered by the victim of resident to resident abuse.

Foreseeability is a major factor in determining whether or not a nursing home may be held liable for a resident’s injuries in a resident to resident assault. It is the nursing home’s responsibility to prevent foreseeable harm to its residents.

This can be done by reviewing prior medical records, speaking with family or friends of the resident, and completing a thorough assessment of the resident upon admission to the facility. Failure to do a proper initial assessment is negligent behavior by a nursing home facility.

How should they handle violent residents?

If a resident has ongoing behavioral issues or violent tendencies towards others, then it is the nursing home’s responsibility to either:

  • Remove the resident from the nursing home or
  • Prevent the violent resident from harming other nursing home residents.

Lower staff to resident ratios may also contribute to resident to resident assault incidents. Improper nursing home staffing may result in many issues, including resident to resident assault. If there is not enough staff for the amount of residents at a facility, then the resident’s needs may not be met in a timely manner. This may cause a resident to become agitated and become violent with other residents.

Because residents that attack other residents usually have impaired cognitive ability, it is the nursing home’s responsibility to make sure resident to resident assault does not occur.

Remember, under Federal law residents are promised a safe and healthy environment in nursing home settings.

Resident to resident assault cases

Here are some recent examples of reside on resident assaults that took place in nursing homes:

Male nursing home resident sexually assaults female nursing home resident

A sixty-six year old male nursing home resident with cerebral palsy sexually assaulted an eighty-six year old female nursing home resident.

The male resident preyed on the female resident due to her worsening dementia. The male resident was a known sex offender, which was known by the nursing home prior to the male resident being admitted to the facility. The male resident previously threatened a female caregiver at the facility.

In fact, the male resident had acted aggressively towards the female resident prior to the sexual assault. The staff members at the nursing home were aware of a “relationship” between the male and female residents, and did not believe that the female resident had the mental capacity to consent due to her dementia.

Female nursing home resident shoves male nursing home resident

An eighty-six year old male resident was shoved from behind by a seventy-three year old female resident with known violent tendencies, especially toward the male resident.

The male resident suffered facial and spinal fractures, as well as a brain bleed as a result of the fall. The male resident died shortly after.

The nursing home was held liable for the resident’s death because the nursing home did not take proper precautions in protecting the male resident from the female resident’s violent tendencies.

Nursing home roommates with history of arguing

Two male nursing home residents shared a room for several months. The residents did not get along and frequently argued, which was known by the nursing home facility and its staff.

The nursing home did not move the residents to separate rooms. The facility put a movable curtain between the residents in their room. During another argument between the residents, one of the roomates took a leg rest off of a wheelchair and beat the other resident to death.

Because the nursing home facility did not take proper action when it knew that the residents were verbally aggressive towards each other, the facility was found liable for the resident’s death.As one of the leading causes of wrongful deaths in the US each year, it’s no surprise that there are so many questions when it comes to the topic of nursing home neglect.

According to the National Center for Victims of Crime, over 75% of reported elder abuse is verbal or neglect, meaning tragically there are instances of neglect happening in nursing homes across the country every day.

If your family member or loved one is either moving into residential living or currently lives in a nursing home and you’re concerned about their safety, our frequently asked questions will help to answer some of the questions you may be asking;

What are the main types of nursing home neglect?

There are two types of neglect that occurs within a nursing home setting:

  1. Physical neglect
  2. Emotional or psychological neglect.

Physical neglect in care homes

Physical neglect is slightly easier to spot because there are often visible signs that show your loved one is not getting the adequate level of care nursing homes are required to provide. Physical neglect can include:

  • Not being washed for days
  • Wearing the same clothing for several days
  • Their environment is untidy, dirty or generally neglected
  • Bruising or other visible unexplained injuries
  • A change in their general behavior as they become more emotional or distressed

Emotional neglect in care homes

While physical neglect can be easier to spot, emotional neglect is also a very common type of abuse that happens in nursing homes in Arizona as well as across the US.

The signs of emotional neglect are often more subtle, some of the more common signs of emotional neglect include:

  • Carers singling them out from group activities or general interaction
  • Belittling, bullying and other verbal abuse directed at individuals
  • Being denied rights such as having visitors and even access to food or drink
  • Witnessing any kind of raised voices or general aggression from caregivers

Emotional abuse can be tougher to prove as it typically happens over a longer period of time or even behind closed doors. The more common signs listed above can be spotted by visitors or loved ones but often over a period of time as their family member’s behavior typically declines.

What are the first signs of nursing home neglect?

This depends on the type of neglect taking place, but there are a few different signs to look out for in both, including significant changes in behavior from your family member or loved one.

It can be difficult to spot emotional neglect as but some signs to look out for in your loved one, should you suspect there is emotional neglect happening can include:

  • A change in behavior from your loved one eg. becoming withdrawn, emotional or depressed
  • Finding them alone or shut away
  • A general despondent approach to doing anything

With physical neglect there you are more likely to notice changes in appearance, other things to look out for include:

  • Wearing unwashed or soiled clothing, or seeing them in the same clothes repeatedly
  • A messy environment; untidy, unhygienic or generally unkept
  • Dirty finger and toenails left uncut or visibility unwashed
  • Having lost or gained an unusual amount of weight
  • Being visibly dehydrated or left without water
  • Being physically isolated from others or left alone for a long period of time

How can you investigate nursing home neglect?

The law in the state of Arizona allows a direct relative of someone in a nursing home who suspects abuse is happening, to file a formal complaint against the nursing home.

To begin the investigation contact The Arizona Health Services Department either by:

  • Completing a form on their website
  • Calling them directly on 1-602-364-2536.

You can read our article about where to file a complaint here for more information about starting any kind of complaint against a nursing home in Arizona.

Once you’ve filed the complaint, you should then consider speaking to a legal professional about your legal rights as a family member. Neglect within a nursing home is often a complex and emotionally charged legal case so hiring a legal representative will help take some of the burden and emotional stress away.

Investigating neglect is something an experienced attorney will be highly competent in doing, representing your family member in a legal capacity.

They can also advise you on what you can do to assist your case, including things like collecting photographs or keeping a log of behavior on behalf of your loved one.

Can a nursing home sue you?

There are a few limited circumstances in which a nursing home can sue a resident, for example if they fail to keep up the regular payments. There will be a contractual agreement in place before moving in so it is important to have a plan in place about paying for the care before this happens.

If you’ve filed a formal complaint or even raised issues with the manager of a nursing home about the neglect of a loved one, and are now concerned about them suing you, it’s important to learn about your rights.

Nursing homes have a certain obligation to supply a level of healthcare to its residents but once a resident goes into hospital, it’s not their responsibility to pick up the medical bills.

Again, if you or your family member doesn’t pay the medical bills for health issues that are ongoing, you will need to ensure they get paid.

Can I still visit if I make a complaint about neglect?

Yes, if you’ve raised concerns about a home you are still in your legal rights to continue to visit a loved one. Nursing home staff should not discourage or prevent you from visiting a loved one in any way.

If you’ve made a formal legal complaint these are handled anonymously in Arizona.

How often should a nursing home change a patient’s diaper?

This is a rather specific question that is often asked by family members of residents suffering from incontinence.

If your family member wears a diaper, a nursing home should be checking it every two hours and changing accordingly.

If you’re worried this is not being changed regularly or there are sores starting to appear, raise it with the manager immediately. Sadly, it is common for a nursing home to neglect residents who rely on adult diapers, forgetting or not checking regularly enough which can lead to urine burns and sores caused from the diapers.

Not changing a diaper is another form of neglect and is something that needs to be addressed. If you suspect your loved one may not be helped often enough with changing, make sure to keep a log and try to remind the staff as often as possible.

What are some of the causes of nursing home deaths?

Tragically, when neglect is left unnoticed or carries on for too long, it can cause other health conditions that may lead to a wrongful death happening. Wrongful death is defined by something that could have been prevented, such as neglect, and is often the legal outcome of a nursing home neglect case.

Death within a nursing home setting that can be directly related to neglect can be caused by a number of factors including:

  • A slip or fall resulting in injuries or instant death
  • Infection caused by something preventable e.g. a wound or urine infection.
  • Accidental medicine doses
  • Being left for a long period of time after a fall or injury

While there are many natural causes of death within a nursing home, sadly a high proportion are a direct result of neglect. Neglecting the most vulnerable members of society will always have much more severe consequences and sadly often ends with preventable death.

Dorosti v. Recovery Innovations of Arizona: An example of neglect causing wrongful death

A real-life example of neglect causing a wrongful death within a residential home is the Dorosti v. Recovery Innovations of Arizona, Inc case.

A resident by the name Dorosti lived in a psychiatric facility due to living with bipolar; a serious mental illness that meant he had become a danger to others as well as himself.

Dorosti had a long and complex mental health history throughout his life, but tragically the home where he was living when his wrongful death happened had been proven to significantly neglect Dorosti and the care he needed.

An experienced attorney representing Dorosti showed that the psychiatric home had:

  • Failed to manage his medication and manic behavior appropriately
  • This failure then caused his mania to escalate
  • This led to an attempt to use restraint, which resulted in an assault from an unqualified and unlicensed recovery coach

Due to the severe level of neglect Dorosti experienced that led to his death, the psychiatric home was found to be fully liable and responsible for a death that could have been easily prevented.

The surviving family of Dorosti was awarded $2 million in compensatory damages after the case was settled in court in front of a jury.

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