Healthcare News & Insights

Nightmare at the nursing home shines light on geriatric care crisis

wheelchair

A 100-year-old woman was allegedly strangled by her roommate at a nursing center — just steps from the nurses’ station. Could staff have prevented it?

A heartbreaking crime in Massachusetts is shedding new light on a problem front-line staff are all-too familiar with: Violent, disruptive behavior in nursing homes and geriatric care wards.

Elizabeth Barrow, 100, was found strangled and suffocated with a plastic bag tied over her head at Brandon Woods Nursing Home in Dartmouth, MA.

Her roommate, 98-year-old Laura Lundquist, has been charged with second-degree murder. Because Lundquist has a long-standing diagnosis of dementia, the prosecutors and defense attorney have jointly requested a competency hearing for Lundquist.

A trial is possible, but not likely, given Lundquist’s age and health.

Whatever the legal outcome may be, there are sure to be questions about how this could have happened in a facility that provided 24-hour monitoring.

History of conflict — and violence

Staff at the nursing home said that Barrow never claimed to feel threatened. But there was a history of conflict between the two, who had been roommates for just over a year in a tiny, 420-square-foot room.

Lundquist had made many comments about Barrow trying to “take over” the room, and had exhibited other erratic behavior, including saying that a prior roommate had tried to strangle her in bed. She also said that she would get Barrow’s coveted window-side bed, because she was going to outlive her.

In July and August, staff were concerned enough about the situation to offer the women new room assignments.

The night before Barrow’s murder: The women argued over a table Lundquist placed near Barrow’s bed, limiting Barrow’s access to the bathroom. When a nurse’s aide moved it, Lundquist physically attacked her.

But nursing staff didn’t separate the women. The next morning, nurses saw Barrow get up to use the bathroom at about 6 a.m. At 6:20 a.m., a nursing assistant found Barrow dead with the sheet pulled over her face and a plastic bag tied around her head.

Challenges of geriatric care increasing

Besides the usual interpersonal conflicts that arise whenever people have to share space, dementia and other ailments can lead patients or residents to exhibit behavior far removed from their usual character.

And staff may have trouble determining which arguments are just sniping that will blow over by dinner and which will escalate to violence — or even murder. Facilities with space limitations can’t always play it safe by separating patients.

Some strategies that help:

  • Have single rooms or other back-up quarters always available so that if an emergency situation arises, staff can take action.
  • Retrain staffers frequently on communication techniques specifically for working with geriatric patients, especially those with dementia or similar conditions.
  • Remind all employees to be on the watch for personality or behavioral changes that may be red flags of a deteriorating mental state or impending violence.
  • Keep patients’ families as well as treating physicians alert to observed behavior to better identify when a patient seems to be undergoing a change in personality.

Subscribe Today

Get the latest and greatest healthcare news and insights delivered to your inbox.

Comments

  1. This was a very unfortunate incident and i feel for both the families and staff involved. Geriatric care has become so difficult over the years and you never know what some of these elderly folks are capable of. Although if the roommates had not been getting along one of them should have been moved out of the room. It is so difficult to find the perfect roommate sometimes and rooms are small for 2 people to share. One question is did the 98 year old have a history of violance or mental illness of any kind. Sometimes the facility staff is not made aware of these things because the family of the resident don’t feel it is important to mention if there loved one had issues in the past, but it is very important. I feel there is alot more to this incident.

  2. I work in the same kind of environment, and the advice given is good — but only up to a point. It’s very difficult to maintain empty beds, especially if you’re in a center that does both long- and short-term care simply because it’s extremely difficult to predict how many admits you’re going to have (we often have just a few hours’ notice) and what kind of infection control issues you’ll have to deal with.
    More importantly, it glosses over a long list of potential issues with both the residents themselves and their families. In most states, you cannot change residents/patients’ rooms without permission from the resident and/or their representatives, unless you have a very clear-cut case of potential endangerment (due to behavior, infection, or other causes) if a change is not made. I’ve lost count of how many times we’ve had roommates — sometimes after many months without problems — take a sudden dislike to each other and yet each insists the other has to move, they’re staying put. Even more frequent is the issue of families who can’t/don’t/won’t accept either the realities of mental status changes or who simply believe the facility is out to “get them” for any number of reasons. It doesn’t matter if the family visits every day or can only be located when the moon turns blue; we have a legal obligation to listen to them, and often discover we’re not living in the same reality.
    Incidents like the one in the article are mercifully rare, but the bottom line is that facilities often have their hands tied due to (sometimes conflicting) legal requirements. Yes, some facilities simply do what they want to and let someone else worry about the repercussions (usually when money is involved), but those that actually pay attention to rules & regs and try to work within those guidelines often find themselves between the classic rock & hard place.
    Sorry… I guess I just took a lot of words to say, “none of the answers are as simple as they appear at first glance.”

  3. Charlie Tame says:

    Can we just say blame the Government? Medicare / Medicaid will not pay for private rooms, of if a nursing home makes a choice to put people in private rooms guess who pays? And Nursing homes are not usually charities, and their costs can be amazingly high. A facility with 200 rooms is probably paying a quarter million a year in city taxes and another quarter million in energy / water and maintenance costs. That’s half a million before they even get one nurse or CNA. This is one reason why a lot no longer want to do dementia care, because this kind of thing can be totally unpredictable but you can bet now the facility will be subjected to state inspections and “Federal Focus” watch lists until the staff are driven crazy and the owners decide to sell. As a simple example of how contradictory the law can be you can’t “Restrain” residents or keep then behind locked doors, but at the same time you will get fined and ultimately denied all medicare / medicaid payments if residents “Wander” out of the building. And of course families are reluctant to mention any former incidents because as it gets harder and harder to find a place for their loved ones they get to figure out that the less they say the better…

  4. Carol Katarsky says:

    Brian: Thanks for sharing your insight. I hope I didn’t give the impression that these are easily solved issues — certainly they’re more complex than we have the space to deal with here. Similarly, I don’t doubt the staff at this particular nursing home did everything they thought was appropriate. It’s very easy to look back in hindsight and find things they could have done differently, but we weren’t there at the time having to make decisions.

  5. Marilyn Regier says:

    As I read responses, one more aspect needs to be mentioned. No long term care facility that I know of has sufficient amount of staffing to provide true “24 hour monitoring” to every resident of a facility. To do this would require a one on one staff ratio. A nursing home does have difficult decisions to make in delivering care many times, and I would also be glad that tragic incidents like this are fortunately rare. I applaud the staff that does their best to give the residents the best quality of life possible.

  6. Charlie Tame says:

    So far I agree with everything said, and I think Brian laid out the “Care” issues brilliantly.

Trackbacks

  1. […] Nightmare at the nursing home shines light on geriatric care crisis HealthExecNews.com delivers the latest Healthcare news once a week to the inboxes of over 30,000 Healthcare professionals. […]

Speak Your Mind

*

css.php