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.

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