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Resident-to-resident incidents are a hidden source of harm in nursing homes. They shouldn't be.

Written by Elder Voice's Eilon Caspi

Dwayne E. Walls was a Korean War Veteran and an investigative reporter at the Charlotte Observer. Throughout his distinguished career, he wrote stories on social justice issues from the inner circles of the Ku Klux Klan and the homes of poor Black farmers; about voter fraud and the dysfunctions of the coroner system. His best stories were about vulnerable populations. Little did he know he would one day become part of one.

Walls developed Alzheimer’s disease. When he declined and his wife, Judy Hand, could no longer care for him at home, she moved him to a nursing home in South Carolina.

One evening, Walls walked into another resident’s bedroom and climbed into the empty bed. Moments later, the resident who lived in the room, an 88-year-old man with dementia, beat Walls with his cane. Walls was found severely injured, bleeding, and unconscious in a fetal position on the floor. He died a week later.

The phenomenon of resident-to-resident incidents in nursing homes is more common than most people think. A large Cornell University study found that one in five nursing home residents had been involved in such incidents in a single month. These incidents can be injurious, and even deadly.

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Yet due to a series of factors — insufficient research and barriers to conducting it, residents’ advanced dementia limiting their ability to recall and report incidents, and nursing homes’ reluctance to participate in studies due to fear of adverse publicity — no one really knows just how often these incidents occur.

Resident-to-resident incidents are defined as “negative, aggressive, and intrusive verbal, physical, material, and sexual interactions between long-term care residents that in a community setting would likely be unwelcome and potentially cause physical or psychological distress or harm in the recipient.”

These incidents often occur when nursing home residents with dementia invade the personal space of other residents. It may be something like walking into their bedrooms or bathrooms, or taking food or other belongings from them. Conflicts between roommates is another common scenario.