At first glance the headline strained the bonds of credulity. But there it was, earlier this year, above a story about an 86-year-old and a 79-year-old brawling over a chair before a bingo game in the Canadian nursing home where they resided.
According to the account, others joined in, escalating the incident to the point that police had to be called.
“It was certainly an unusual call for us,” Police Constable Sandra Barr told CBC News.
The incident led to cheap jokes, most notably on the part of Saturday Night Live “Weekend Update” anchor Michael Che, but brought attention to a serious problem: Resident-resident conflicts in skilled nursing facilities like the six in The Allure Group’s network, based in Brooklyn and Manhattan.
One study showed that there were 7,000 such incidents in 2013 alone. Another study, undertaken a year later by Karl Pillemer, a professor of gerontology at Weill Cornell Medical College and professor in Cornell University’s Department of Human Development, examined 2,000 residents in 10 New York State eldercare facilities, and revealed that one in five residents were involved in at least one “negative and aggressive encounter” with another resident in a four-week period.
Of those who were victimized, 9% reported the abuse as being verbal in nature, while 5% said it turned physical. Another 5% suffered an invasion of privacy, while one percent were victims of sexual abuse.
Some conflict is bound to occur when many people are living in a confined space; in the case of The Allure Group, for instance, there are over 1,400 residents scattered among its six facilities. Pillemer listed overcrowding as a factor in the conflicts, and that looms as an increasing concern as the U.S. population ages and the number of people in need of residential care skyrockets. It is projected that by 2060, 98 million Americans, some 24% of the population, will be 65 or older.
There are many other physical, mental and psychological factors that contribute to conflict, not the least of which is the fact that some residents bristle at losing their independence. The impact of such conditions as Alzheimer’s and dementia cannot be overstated.
Another contributing factor is understaffing, leading to frustration not only on the part of the residents, but the caregivers themselves. That has further led, sadly, to incidents of elder abuse. According to Nursinghomeabuseguide.org, one in six residents may be the victim of abuse or neglect every year.
Conflicts between residents are not nearly so widely examined, though Pillemer mentioned two other factors — staffers who “can become somewhat blinded” to the issue because of its frequency, as well as the “contagious” nature of such negative behavior:
“Seeing these incidents causes other residents to be fearful, anxious, concerned — and that can lead to more of the behavior.”
He firmly believes that bullying occurs in nursing homes, as assuredly as it does in middle schools — that younger and more physically active seniors were more likely to instigate abuse. At the same time, Pillemer mentioned cognitive impairment (i.e., that which might result from dementia or Alzheimer’s disease) as a major risk factor in such episodes.
A community relations director at Florida senior living facility agreed, while also telling the website Agingcare.com that a urinary tract infection (UTI) can lead to emotional outbursts as well. She added that medication problems or health complications are other potential triggers.
In addition, Aging.com mentioned that conflict might arise out of such things as a simple personality difference between a staffer and a resident, or a desire for control on the part of a resident who is left feeling powerless in an institutional setting. Becchio’s example was that of a woman who refused to eat, no matter what was put in front of her.
In all those examples the onus was placed back on the staff. If there is a personality difference, it was suggested that a different staffer might be better-suited to working with a given resident. If bullying is occurring, maybe a meeting with a manager is in order. Same for the case of resident seeking to stay in command. And if someone has grown unruly because of dementia or Alzheimer’s, he or she might be better off in a special unit for such patients.
The latter is the case at The Allure Group. A dementia and Alzheimer’s program, complete with reminiscence therapy, is available at our Bedford, Linden and King David Centers. And technology has long been part of Allure’s backbone. At Linden Center we employ the Snoezelen Multi-sensory Environment which helps patients reduce agitation and anxiety. Snoezelen also promotes patient engagement by stimulating reactions and encouraging communication.
The challenge of resident-resident incidents will always be there, however. In fact, it promises to become greater as time goes on and Americans continue to age. A proactive approach — one that includes innovative, creative thinking — will continue to be the best MO.
Joel Landau is the founder and chairman of The Allure Group, a rapidly expanding provider of skilled nursing and rehabilitation services throughout the New York downstate area. Landau is also the co-founder and managing director of Pinta Capital Partners.