A 70-year-old nursing home resident (Resident 1) was arrested on June 12, 2023, after a physical altercation with an 87-year-old resident (Resident 2) led to Resident 2’s death. Resident 1 was charged with second-degree manslaughter, first-degree reckless endangerment, third-degree assault on an elderly victim, criminally negligent homicide, and third-degree assault.
The charges stem from an incident that occurred a year previously. Resident 2 told police that he had been arguing with Resident 1 over the course of a week before the incident. Resident 2 said he was hard of hearing, so he turned the volume of his TV higher than normal, which bothered Resident 1, who was residing across the hall from him.
Resident 2 said that on June 2, 2022, Resident 1 pushed him, which caused him to fall backward. He hit his neck on the metal door frame and fell to the ground. He was unable to get up and was transferred by ambulance to the hospital for treatment.
Resident 1 told police he had walked over to shut Resident 2’s door due to the TV’s volume, and Resident 1 opened the door to confront him. Resident 1 said they argued, and he then pushed Resident 2’s walker, but that he did not physically push his body.
Resident 2 had surgery for his fractured neck on June 4, 2022, but he died on June 17. The Chief Medical Examiner ruled his death a homicide due to blunt force trauma to the neck.
Compliance Perspective
Issue
Failure to prevent a resident from attacking another resident and failure to perform a Preadmission Screening and Resident Review (PASARR) to accurately assess a resident’s risk for aggressive behavior or provide adequate monitoring and services, may result in citations for immediate jeopardy and provision of substandard quality of care, in violation of state and federal regulations. Staff should monitor for any behaviors that may provoke a reaction by residents or others, which include, but are not limited to:
- Verbally aggressive behavior, such as screaming, cursing, bossing around/demanding, insulting to race or ethnic group, intimidating;
- Physically aggressive behavior, such as hitting, kicking, grabbing, scratching, pushing/shoving, biting, spitting, threatening gestures, throwing objects;
- Sexually aggressive behavior such as saying sexual things, inappropriate touching/grabbing;
- Taking, touching, or rummaging through other’s property; and
- Wandering into other’s rooms/space.
Resident-to-resident abuse could also involve a resident who has had no prior history of aggressive behaviors, since a resident’s behavior could quickly escalate into an instance of abuse.
Discussion Points
- Review policies and procedures for accurately assessing residents before and after admission for the risk of aggressive behavior and for ensuring adequate supervision and appropriate room assignment are provided based on their history and current status.
- Train staff about the risk for aggressive behavior by any resident and their responsibility to monitor and note changes or patterns of behavior that may indicate increasing aggression. Also train staff on behavioral health protocols and the importance of reporting distressing behaviors immediately to a supervisor. Teach the reporting process, including how to access the Hotline if anonymous reporting is preferred. Document that these trainings occurred and file the signed documents in each employee’s education file.
- Periodically audit the risk assessments of residents with histories of aggressive behaviors to determine if they are being monitored and if changes are being noted on their care plans. Also audit to ensure that all staff are knowledgeable of behaviors that should be reported immediately to a supervisor, and the process for reporting.
*This news alert has been prepared by Med-Net Concepts, LLC for informational purposes only and is not intended to provide legal advice.*
