kicked-in-the-faceI remember reading what I considered to be a dramatic article about violent nursing home residents, written by Thomas Zambito (The New York Daily News, December 18, 2000).

He wrote of ‘three slayings of nursing home residents by other residents in the past six years, including one in which a Manhattan woman was suffocated by her 90-year-old roommate. In the past year alone, government health inspectors have cited three New York City homes for failing to protect residents from one another’.

This struck a chord with me, as I had begun to witness the admission of patients with violent behaviour into for-profit nursing homes, allowing them to live side by side with the frail and vulnerable. The profit motive (bums on beds) was the reason; with managers of these homes being under pressure to accept almost anyone by avaricious and debt-ridden owners. One manager told me that she had been told to accept Jack the Ripper, if necessary.

It was the legal aspect of such admissions that I questioned. Mr. Zambito’s article stated that: ‘the state Health Department singled out Brooklyn’s Rutland Nursing Home for jeopardizing the safety of elderly residents by allowing them to live side by side with dangerous residents’.

I questioned the legality of admitting patients with violent behaviour, given that nursing homes are places where frail, elderly people live close together, and can not escape from a violent attack, nor be protected from one in an industry where short staffing is endemic. These problems have been compunded over the last two decades or so, as many psychiatric institutions shut their doors, and nursing homes have taken in more mentally ill patients than ever.

I agreed completely with Mr. Zambito’s summary: ‘Resident-on-resident violence and harassment have been getting worse for years, fueled by dramatic shifts in nursing home populations that have created a volatile mix of residents‘.

Where are the special units for the growing numbers of residents with behavioral problems who are being discharged from hospitals and psychiatric facilities?

Moving on a to 2012, data from the Canadian Institute for Health Information (OANHSS), found that 8,400 residents of Ontario long-term-care homes rate high on a scale of aggressive behaviour. The scale looks at whether residents are physically abusive, verbally abusive, physically resistant, require restraints or exhibit inappropriate and disruptive behaviour. Some who not too long ago would have been housed in psychiatric facilities or in complex continuing-care beds are now finding themselves in long-term-care homes, explained Jane Meadus, a lawyer with the Advocacy Centre for the Elderly.

Moving on to May, 2015, ‘the daughter of an elderly man killed in a Winnipeg care home is happy a judge is recommending more special behavioural units be created in Manitoba to deal with patients with violent or aggressive tendencies’ ( news).

There are many types of abuse we heap on the discarded elderly – institutional abuse, which includes cutting back on food, heating, inappropriate care workers being employed, loss of dignity and respect, discrimination, neglect, financial exploitation, emotional abuse, and sexual and physical abuse – but let us add to that list and say that the admission of a patient with violent behaviour into a short-staffed nursing home is a heinous crime of neglect of care, of poor vigilance, driven by the profit motive.

The practice of admitting unstable patients to nursing homes is as prevalent in the UK as anywhere, take  time to read Alzheimer’s Society forum posts, but reports of patient-on-patient violence in nursing homes in the UK do not seem to make news headlines. Are we brushing this issue under the carpet of patient confidentiality, and, by this, protecting care home companies and compliant nurses? Does it help that the CQC does not enforce the requirement for a nursing home to have a qualified nurse as manager, who would be duty bound to protect their residents (and staff) against the inappropriate admission of violent patients?

Drag the executives of nursing home companies who allow an unsafe mix of residents in front of the courts.

Remove any nurse complicit in this abuse from their professional register.

Get rid of the CQC; their penalties are like being hit by a wet lettuce.

Place all reports of serious patient-on-patient violence in the public domain, altering names.
lenin nightingale 2015



  1. I worked at a CARE home of a big provider. We had a resident who started attacking staff, this went on for hours. I called the GP a few times and later found that the manager had taken the call backs. A number of staff were assaulted. We found out later that the resident had been sectioned at a previous home for strangling a HCA. She suffered very bad injuries and has not returned to work The CPNs & Social workers were aware of his history
    Another resident who had stabbed a relative & was an ex convict. (Attempted murder) He had personality disorder but again staff were not told what they were dealing with and were not given any training.
    Yet another had cognitive impairment and was violent towards staff and residents. Again we had no support in dealing with him
    This was an EMI nursing unit for advanced dementia instead it was a free for all.
    The manager would take any resident regardless of whether they could be cared for.
    Fights between residents were almost daily occurrence but the manager wasnt interested
    Staffing levels for advanced dementia, when the home belonged to Southern Cross were excellent, good skills mix and good training. This was reduced to dangerous levels.
    I complained and took out grievances all to to avail, regional managers followed the CARE home owners line

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