Understanding and Preventing Harmful Interactions Between Residents with Dementia

Professional care providers can learn ways to avoid one of the most difficult and often tragic problems to occur in care settings: When residents with memory loss act in ways that harm another resident. Many of these episodes are preventable. Understanding what may provoke a person with dementia to respond in a physically or verbally harmful manner is the key to prevention and mitigation. This book provides the first care standard for the field, presenting practical tools and instruction on how to identify contributing factors, causes, unmet needs, and triggers that commonly lead to serious distress or injury, sometimes even death.

Emphasizing compassionate, person-directed care practices, author Eilon Caspi describes numerous psychosocial strategies to use to prevent and de-escalate situations prior to, during, and after harmful resident-to-resident interactions. Included are dozens of real-life examples illustrating what does and does not work in addressing these episodes.

Based on extensive research and proven behavioral analysis, this valuable resource:

• Identifies 88 factors—personal triggers, interpersonal dynamics, the physical environment—that contribute to harmful interactions
• Describes which factors can be modified and which cannot, and how to work with them either way
• Creates opportunities for significant improvement in resident and staff well-being
• Delivers useful screening and intervention tools
• Provides access to downloadable assessment tools and detailed instructions on how to use them

This critical resource will inform training programs and daily practice for direct care staff, interdisciplinary teams, and long-term care administrators. The recommended approaches will help providers meet federal nursing home regulations, avoid unnecessary legal liabilities, and enjoy cost savings from reduced resident-to-resident incidents. A safer and more harmonious experience can be achieved for all who live or work in care homes.

Eilon Caspi, Ph.D., is a gerontologist and dementia behavior specialist. He is the founder and director of Dementia Behavior Consulting LLC and a founding member, advisor, and board member of Elder Voice Family Advocates. He currently works as an assistant research professor at the Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut. He serves as a board member of the Long Term Care Community Coalition (NYC). He worked his entire adult life in the aging field, starting as a nurse aide in 1994 in a nursing home where his grandfather lived. Both his grandmothers had dementia and lived in nursing homes. Over the years, he served in various roles, including social worker, consultant, applied researcher, educator, author, volunteer, and elder care advocate. Over the past 13 years, he developed and implemented a comprehensive program for the prevention of the prevalent and harmful phenomenon of resident-to-resident incidents in long-term care homes. He regularly presents on the phenomenon at local, state, national, and international professional and scientific forums, nursing homes, long-term care trade associations, the Alzheimer’s Association (U.S. and Canada), the Veterans Administration, the Office of Ombudsman for long-term care, state survey agencies, and coroner offices. He co-directed the first documentary film entitled Fighting for Dignity on injurious and fatal resident-to-resident incidents in dementia (Terra Nova Films). He frequently gives interviews about this phenomenon with media organizations such as The Boston Globe, The Star Tribune, CBC News Canada, The Canadian Press, and Stuff New Zealand. In recent years, he dedicated his research and advocacy to the prevention of various forms of elder mistreatment such as neglect of healthcare, abuse, financial exploitation, and theft of opioid pain medications in assisted living residences and nursing homes. His passion is in bridging between academic/research and care practice/policy. In his free time, he enjoys carving wood and has recently completed hand carving brain hemispheres and educational signs such as SEE ME Not My Dementia, JUSTICE OF ELDERS, ELDERS’ VOICE, and ELDERS’ LIVES MATTER. Eilon lives in West Harford, CT with his wife, two daughters, and their border collie.