As a nurse practitioner consulting on management of aberrant behaviors in residents with dementia in long-term care facilities, I was saddened but not surprised by the report of Larry Rozar’s beating and death (“No answers in Alzheimer’s patient’s death,” Sept. 4 news article).
Private rooms in LTC facilities are expensive. Medicaid pays for double occupancy rooms only. Residents are likely to have shared rooms with only a spouse for decades. Imagine the demented person, who is beyond making sense of his environment, awakening at night in a strange place with a stranger in the next bed. Unable to think this through, primal responses – danger, fear, fight – take over.
Facilities try their best to provide decent care and supervision, but financial considerations win out. Minimum adequate staffing is often the norm. Bedside-level caregivers lack in-depth education about the workings of the demented brain.
Insight, planning ahead, anticipation of the consequences of an action, thinking through a situation before reacting and living anywhere but in the moment all are lost for these patients. This leaves the caretaking environment to anticipate and avoid problems.
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When seeking long-term care for loved ones, look less at the lobby and chandeliers – inquire about staffing ratios (including at night) and turnover of staff.