The Private/Public Dementia Dilemma

"We were told later there were many incidents. There were incidents of violence, incidents against employees, against patients, against staff."
"Now everybody is looking at him as ‘he killed someone’… it’s going to stick with him forever."
Faye Jashyn

The 'he' Ms. Jashyn mentions is her father, 70-year-old Joe McLeod, who in 2011, in Winnipeg, killed an 87-year-old man suffering from Alzheimer's disease. Mr. McLeod had violently shoved the victim, Frank Alexander, causing him to fall and fatally hit his head, causing death. Mr. McLeod was duly charged with manslaughter, but the case was dismissed when Mr. McLeod was found unfit to stand trial, since he too suffered from dementia. 

Both men had been placed in a Winnipeg nursing home by their families who were unable to adequately care for them.

They were placed in a nursing home among medical professionals who knew how to look to the care of such elderly patients who had lost the ability to care for themselves, whose cognitive ability had been irreparably impaired by dementia. In those nursing homes, the families felt that their loved ones would be taken care of, and sheltered from harm, while their health needs were addressed in a manner that they themselves were incapable of performing.

In the process of an inquest that was later held to pursue the matter of violent aggression in such situations, it was revealed that Mr. McLeod, not in possession of full mental faculties, and difficult to control had on occasion attacked members of the care-home staff in episodes of punching and choking. One worker was evidently informed by him that she was going to die; by whose hand, he did not divulge, it seems.

One nursing care facility in British Columbia had installed a closed-circuit video camera to help solve the puzzle that presented itself to the staff of seniors falling in the hallways. Surveillance footage revealed that the seniors were not falling entirely unassisted. There were examples of a resident hitting out at a peer, carefully looking about to determine whether anyone had witnessed the event, then punching and kicking the unfortunate in the head for good measure. 

Perhaps the latent bully in the individual is brought out by dementia?

In the space of the last two years the incidence of nursing home violence due to dementia has grown apace, leading to a dozen homicides, leaving nursing homes in Ontario pleading with the provincial government to allot them additional funding to enable them to institute a preventive measure that to date fewer than one percent of such homes have taken advantage of, in their effort to cut down on this deadly violence.

Of Ontario's 626 long-term care homes, a mere six of those homes have received funding adequate to enable them to hire a team of experts for the purpose of reducing the violence that has become entrenched to the extent that the Ontario Provincial Police, the chief coroner's office, the homes themselves and families who fear their institutionalized loved ones may become the latest victims, have been warned of the crisis. 

In 2010, an 84-year-old man diagnosed with both Alzheimer's and Parkinson's diseases was charged with second-degree murder in the death of another 88-year-old man, also suffering from Alzheimer's, both residents at a long-term care home in Ottawa. The men lived in adjoining rooms, between which was a shared bathroom. And once again, the accused was found unfit to stand trial.

Chief executive of the Ontario Long Term Care Association, Candace Chartier, expressed the deep concern of all representatives from key industry principals: "We're really concerned about violence". And so should they all be. The association is in the process of lobbying the provincial government for an additional $60 million over a three-year period to enable teams of experts to be placed in more of these long-term nursing care institutions.

These behavioural support teams use strategies that have proven to be effective in reducing the incidence of violence among nursing home inmates. Some of the strategies are based on relieving tension by increasing stimulation and exposing residents to enriched programs to divert their attention to more positive outcomes. Careful observation and family interviews are also part of the strategy. 

Within a one-year period one facility using such a stress-reducing team reduced anti-psychotic medications by nearly 50 percent, with residents expressing less agitation, restlessness and conflict.

"The in-home [teams] works best. That's why we advocate for the in-house model", stated Ms. Chartier. She places less value on mobile teams used to visit multiple nursing homes. A survey by the nursing home association discovered that 62 percent of residents in facilities have Alzheimer's disease or other forms of dementia, representing an increase in the range of six percent in the past five years.

Breaking that number down further, close to half of nursing home residents exhibit aggressive behaviour that is related to a mental-health condition, and over one in five (22.2 percent) exhibit severely aggressive behaviours. In addition, in the past ten years as Ontario closed down residential mental-health facilities, some of those patients previously housed in them, were moved to long-term care homes. 

Add all of that to the fact that the number of seniors is steadily increasing as a proportion of the general population and you've got a perfectly dreadful storm ahead.