Violent Residents Cause Concern at Nursing Homes

Nothing seemed out of the ordinary at the nursing home during routine checks on John Tamkun and his roommate, Thomas Mullen. But before the night was over, Mullen was dead, bludgeoned with the footboard of a bed, and Tamkun faced manslaughter charges.

The slaying Sept. 26 and the arrest of Tamkun, a retired cabinetmaker who suffers from dementia, have cast a spotlight on a growing problem at nursing homes across the country: violence among residents.

“They were good friends. They went everywhere together in the facility,” said June Lagan, Wilton Meadows Health Care Center administrator in Wilton. “It was really totally unexpected, unpredictable. The families are as stunned as we are.”

Nursing home administrators have traditionally focused on complaints of staff abuse, but resident-on-resident violence is sparking a growing number of complaints, studies and conferences. Nationwide, more than 3,700 complaints about such abuse were lodged with state ombudsman programs in 2002, up from about 2,500 in 1997.

“There’s so many situations occurring now where there is resident-on-resident abuse, including cases where people are killed,” said Janet Wells, director of public policy for the National Citizens’ Coalition for Nursing Home Reform.

One major reason given for the violence: Nursing homes are caring for greater numbers of older patients suffering from Alzheimer’s and other forms of dementia. Such patients can be both aggressors and victims.

People with dementia can be more prone to aggressiveness.

“They lose their sense of inhibition. They get agitated more easily and afraid,” said Toni Fatone, Connecticut Assn. of Healthcare Facilities executive vice president.

Also, they are likely to wander around or berate others -- behavior that can scare other residents and cause them to respond violently, experts say.

Pennsylvania, New York and Florida have reported cases in recent years of patients at nursing homes killed by fellow residents suffering from dementia.

Toby Edelman, attorney for the Center for Medicare Advocacy, said more staff and better training would allow nursing homes to recognize the warning signs and defuse dangerous situations.

According to the Alzheimer’s Assn., patients often become agitated by change. The group recommends avoiding confrontations and instead redirecting the person’s attention, creating a calm environment, and being sensitive to fears, misperceived threats and frustration.

Tamkun, 88, a new resident, was upset with Mullen, 82, because he made noises and he believed that Mullen was stealing from him, police said.

Better screening of patients for mental illness or criminal backgrounds is needed, advocates say. Nursing homes eager to fill beds have admitted criminals, including sex offenders, Wells said. In Oklahoma, a group called A Perfect Cause warned in May that violent criminals and sex offenders were being warehoused in nursing homes.

In Connecticut, 16 residents of a nursing home in Hartford were killed in a fire last year set by a 24-year-old resident; his attorneys say he is mentally ill. In Manchester, a 23-year-old mentally ill man slashed an elderly resident’s throat because he was upset that the man had taken a cookie from him, police said.

“Nursing homes are admitting people they have no business admitting,” Edelman said. “They don’t have the staff who are trained to take care of the residents.”

Lawmakers are considering action in the wake of Mullen’s death. One possibility is more funding for nursing homes that care for many patients with dementia or other hard-to-handle conditions, one legislator said.