Prevention of Distressing and Harmful Resident-to-Resident Interactions in Dementia in Long-Term Care Homes

As we saw in the Aging in America 2018 session on How to Reduce Senior Bullying, the topic of distressing and harmful interactions between older adults is of keen interest to professionals in the field of aging.

Dr. Eilon Caspi presented a very relevant poster during the Aging in America conference hosted by American Society on Aging. Death of Elders Due to Resident-to-Resident Incidents in Dementia in Long-Term Care Homes.

Eilon Caspi Poster – Death of Elders Due to Resident-to-Resident Incidents in Dementia in Long-Term Care Homes – ASA 2018 PDF

Along with his poster, Dr. Caspi has a $34.90 DVD or on-demand video of a 90 minute presentation he made on this topic in 2016 at the Minnesota Medical Directors Association Annual Conference called “Fighting for Dignity: Prevention of Distressing and Harmful Resident-to-Resident Interactions in Dementia in Long-Term Care Homes.”

The poster focuses mostly on statistics – although there is a “Practical Implications” section that includes the point that private bedrooms rather than roommates are advisable. The video includes more details on steps that can be taken to reduce Resident-to-Resident Incidents.

These slides, taken from Dr. Caspi’s presentation, will give you an idea of the value of the video for your team:

Eilon Caspi Ph.D Research and Website Links

Paper by Dr. Caspi published by JAMDA (Journal of the American Medical Directors Association) in 2016.
Deaths as a Result of Resident-to-Resident Altercations in
Dementia in Long-Term Care Homes: A Need for Research, Policy, and Prevention

A page of Resident-to-Resident Incidents in long-care homes reference links from Dr. Caspi’s website.

Eilon Caspi’s archival blog: Prevention of Distressing and Harmful Resident-to-Resident Interactions in Dementia in Long-Term Care Homes

The Successful Case Study of Judy Berry’s Unusual Lakeview Ranch for Older Adults with Dementia Who had Been Removed from other Facilities Because of Challenging Behaviors

I loved Eilon Caspi’s story about Judy Berry in his presentation. I googled her and found this great story about Judy Berry and her Lakeview Ranch project, and I reached out to her.

This is the Lakeview Ranch case study from the US Dept of Health and Human Services Agency for Healthcare Research Quality (AHRQ) website.

Judy Berry wrote:

“I have known and worked with Eilon Caspi for many years. We have collaborated on many projects and still do. I have seen Eilon’s presentation and was impressed. He is really dedicated to eliminating Resident to Resident Incidents.

How to eliminate bullying between residents and how to “Prevent” challenging & aggressive behavior in persons with dementia … This is done by meeting the often unrecognized underlying emotional and spiritual needs of those with dementia in addition to their physical needs. That was the focus of what I developed at Lakeview Ranch and then operated for 17yrs. Our target population was persons with dementia and a history of repeated hospitalizations and discharges from facilities for challenging behavior.

I retired from the Ranch in 2014 and now do consulting with others on what I learned. Unfortunately most places don’t want to even look at ways to re-appropriate the funds necessary for “higher staff ratios, extensive, specialized, and ongoing staff AND management training”. Onsite RN staff oversight and support is Critical.

Over the 17 yrs. we provided care to roughly 230 residents AND their families. I did research in collaboration with the Gerontology Dept of SCSU in St Cloud MN. and the results were that we eliminated 93.3% of all behavior hospitalizations in persons who were never able to be appropriately supported in other environments without lots of over-medication. Most of our Residents came to us from repeated psych unit hospitalizations. Our RN’s immediately started to reduce the psychotropic meds and within 3 weeks we could see the person’s personality returning while coming out of the medication induced fog.

In 2010 I won one of the prestigious National RWJF Community Health Leaders Awards for my work. I passed that recognition on to my Direct Care Staff as THEY are the ones who actually are making the everyday difference in the lives of our loved ones with support from the rest of our team.

It is my opinion, that most managers of healthcare facilities do not understand ONE critical point. Their success at their job, is only possible if they recognize that the attitude & contributions of the Direct Care Staff is what makes them successful.”

Eilon Caspi wrote:

“I am very glad you spoke with my friend and colleague Judy Berry. She proved that there is a fundamentally different way to connect with, support, and care for elders living with dementia. She demonstrated that when you predominantly focus on the person as a human being first and proactively meet her or his emotional, psychological, social, and spiritual needs, the majority of what is commonly labeled as “aggressive” behaviors is not truly aggressive behaviors but desperate effort by a person with a serious brain disease to cope with increasingly distressing and frustrating daily life situations. She and her highly staffed and trained care team showed that the majority of these expressions can be prevented without psychotropic medications. she proved that close trusting relationships with people living with dementia and careful attention to meeting their emotional needs can enable these vulnerable and frail individuals to live their life to the fullest possible despite having substantial cognitive disabilities.

I am continuously saddened by the discontinuation of the sorely needed innovative model Judy developed; these rare care homes should have been replicated across the country.”