Crystal Ball Care

Today I read about a shooting in another retirement home setting in Detroit. Evidently, a 65 year old man was distraught about his female companion ending their relationship. He chose to single out two other women, shooting them both fatally, blaming them for the break-up.  I think the lesson we all learn here, is that violence  does not discriminate; regardless of race, social class, location or age.

We as long term health care facility administrators write policies about weapons, banning them from being brought inside, by anyone. Policies are useless when dealing with independent and assisted living facilities. How would one even begin to monitor what is brought inside when we are under strict mandates to “regard patient privacy.” It is indeed a double edge sword.

Back in February 2013, an 87 year old man in Washington State opened fire in an assisted living, injuring a nursing supervisor. Luckily, the supervisor was only grazed by the bullets, fully recovering from his injuries. The elderly shooter explained to the police officers how he been abused by the the victim and killing him would be the best thing that could happen.  The assisted living administrator denied any finding of abuse, the elderly man was carted off to jail, and the supervisor returned to his job a few days later. 

Back in the late 90’s I worked in a facility where two elderly men got into an altercation, beating one another with their fists, lamps, and anything else they could manage to throw at the other. Of course all of the governing agencies demanded an explanation of how we as a facility “let this happen”. Ummmmmmmmmmmm. How did we let it happen? I guess the only explanation I have is that I left my crystal ball at home that day and hadn’t consulted with the facility psychic in over a month. My bad.  Seriously?

In the state of Virginia, we are mandated to check the Virginia State Sex Offender Registry, but nothing more on prospective residents. We do not know their history, or the lack thereof. We assess medical issues, their cognitive  abilities and assess their needs. We know strictly what we are told by the family and medical records. Maybe we should know more about the people who will live out their final days with us, but again, we have to regard their privacy. I guess the man in Detroit who shot those ladies today, Im sure he appreciated his right to privacy. The same is true of the 87 year old man in Seattle. Privacy.

A few years back I was asked to assess a 70 year old man from a local group type home setting. He appeared to have mild to moderate dementia, appeared a tad forgetful and had some cognitive impairments. He seemed suitable for placement in the facility.  The social worker assisted him with placement said to me, “Oh, do you need to know about his criminal record?”

Criminal Record. That’s a whole new line of questioning, which is outside of my scope of practice. “Sure, what can you tell me”,is the best response I could conjure up, careful to not violate any privacy rules. After a lengthy explanation of how he had served 40 some odd years in prison for murder…murder….MURDER, he was now MANAGED on meds, and she DOUBTED he would have ANOTHER psychotic episode. She doubted!  I don’t know about you, but I don’t really believe in crystal balls or psychics, so her word choice of ” I DOUBT” was rather defining for me.   I declined to admit him in the facility.  Of course, he too needs care, but I just didn’t feel I could trust the words “I doubt.”

I imagine that as time goes on, we will see more and more residents who have a history of violence, seeking placement in assisted livings and nursing homes. They too, well need care, but how are we as administrators supposed to avoid “letting bad things happen.” Maybe I should invest in one of those crystal balls……………Image





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