Photo: Georgie Williams appears in the above photo with her grandson. She lived in a Virginia nursing home another resident attacked her. She later died. (Bill Tiernan/Virginian-Pilot)
Part 1. Read Part 2 here.
NORFOLK, Va.--The nursing home Georgie Williams moved to in her 80s was supposed to be a haven from the deepening confusion of Alzheimer's disease.
The locked unit in the Windsor home did protect her for a while from things like leaving the stove on or wandering away. But on Feb. 16, 2013, danger came looking for her while she lay in bed.
Another resident, age 77 with a history of dementia and hallucinations, entered her room, sat on her bed and pummeled her face, neck and arms, according to police and medical records.
A nurse responding to Williams' screams caught him with his fist drawn back. It took three nurses to pull him off.
Williams' experience is not commonplace in long-term care, but some experts say the danger is increasing as a widening mix of frail elderly people and
Nursing Home Abuse
A Tale of Two Victims
Virginia elders advocate Susan Potter, who has acted as a legal representative for older people, said she's long been concerned about the mix of people who end up in assisted-living facilities and mom-and-pop adult homes, with the frail and vulnerable living alongside the unstable and restless.
"Few attempts have been made to create an appropriate living environment in the community for the seriously mentally ill," Potter wrote in an e-mail. "Jail, assisted living and guardianship have emerged as little more than band-aids."
Assailants are victims, too. Donna Brown, daughter of the man who assaulted Georgie Williams in her Windsor, Va., facility, said she struggled to find him a safe home when dementia led him to wander from his Norfolk senior housing unit.
The Windsor facility was just one of several places where he landed. After The Pavilion, he went to an assisted-living facility in Portsmouth, Va., but was evicted after he twisted a nurse's arm. Finally, he moved to a place on Virginia’s Eastern Shore, where he died in October 2013.
"If I had a million dollars, I'd open a place where everyone had a room of their own," Brown said. "It's hard for them to be mixed up with the general population. My father wasn't physically ill, just mentally."
His journey from home to home is a common problem borne out in figures that Latimer keeps. During the past four years, Virginia’s long-term care ombudsman program has seen a 24 percent increase in the number of complaints from people who say they have been unfairly evicted, transferred or discharged, often the result of a behavior issue.
Brown said it took her three days to find out where her father was after the February 2013 incident.
Lorenz, too, received little information from the nursing home about her grandmother: "The only communication we had was from the administrator who called to ask when we would be bringing her back. We let them know, 'Never.'"
Elder abuse brings to mind mistreatment by caregivers, but studies suggest resident-to-resident attacks are more common.
A 2014 study by Cornell University found that 1 in 5 nursing home residents were involved in at least one aggressive encounter with fellow residents in the previous four weeks. A 2013 University of Pittsburgh study, funded by the Department of Justice, found that 13 percent of assisted-living residents had been involved in arguments with other residents, 6 percent had experienced an aggressive act, and 4 percent were bullied.
These risks are unfolding on a national stage, where positive trends have led to some negative results:
* People are living longer, putting them at greater risk for dementia, which can lead some to lash out in confusion and anxiety.
* People are surviving serious accidents and war trauma, some with brain injuries that leave them with poor impulse control and aggressive tendencies.
* Those with serious mental illness are being moved out of state-run institutions into communities, putting them in neighborhoods that don't have proper support.
It's a world where assailants and their prey fall into the same category: Victims of disease and disability with fraying family networks who are moving from institutions to places unprepared for them.
"They are invisible populations, but they are there, and they are increasing in numbers," said Robert Palmer, MD, who directs the Glennan Center for Geriatrics and Gerontology at Eastern Virginia Medical School. "I don't think as a society we have thought enough about how to help them. It's a topic buried deep in the American consciousness."
It's a societal crossroads that Elizabeth Lorenz of Chesapeake never imagined for her grandmother: "I go back to what she must have been thinking lying there: 'Somebody help me.' "
Lorenz and relatives had spent months looking for just the right place for Williams, a longtime Portsmouth resident. They settled on Consulate Health Care of Windsor in Isle of Wight County, and she moved there in 2010.
For a few years, everything went well. As time went on, they noticed some lapses in care. Then one night in February 2013, Windsor police came to Lorenz's door: Her 84-year-old grandmother had been involved in an altercation.
Lorenz drove to Sentara Obici Hospital, thinking her grandmother had gotten into a minor tussle over someone taking something from her room. What she saw stunned her: Dark purple bruises surrounded both eyes. Her grandmother's left cheek was bruised and the skin torn. Her arms were cut and bruised.
Her vision was so blurred from the attack that she couldn't make out visitors. When Lorenz drew close to her, Williams instinctively put her hands up, drawing back in fear.
She never spoke again, never got out of bed and died eight weeks after the attack.
"She was never the same; she was just a shell," Lorenz said.
Her assailant, Donald Brown, suffered from dementia and hallucinations, according to medical and police records. He was held on a temporary detainment order and transferred to The Pavilion at Williamsburg Place psychiatric hospital.
It is not Brown that Lorenz has a problem with - it's the nursing home: "I know everyone needs a place to go, but still, there should be designated places to keep them safe with staff and attendants trained to care for them."
In November, Williams' estate filed suit against the nursing home for $2 million, alleging the home did not protect Williams from a resident with a known history of mental illness and aggressive behavior.
Carlton Bennett, the attorney representing the Williams estate, said these types of cases have been on the rise the past decade. Assisted-living facilities can be particularly risky because many of the people there are mentally unstable but robust enough to hurt others. That's also where a growing number of people are living.
Another case Bennett's firm handled involved William Ruffin, 42, who attacked Violet Compton, 92, in the lobby of Oakwood Assisted Living in Suffolk in April 2012. Ruffin was found not guilty by reason of insanity and is at Eastern State Hospital in Williamsburg, a facility he had been in and out of for years.
The operator of Oakwood, Scott Schuett, had his state license to operate assisted-living facilities revoked and has filed for bankruptcy.
Compton died 10 months after the attack; no money has been paid to her family.
While nursing homes are required to have liability insurance to cover malpractice claims, assisted-living facilities are not, leaving families with little recourse.
State long-term-care Ombudsman Joani Latimer said federal law requires people to be moved to "least restrictive" settings, and Virginia is under a Department of Justice order to move people out of state facilities.
People with intellectual disabilities who are moving out of training centers receive some funding through what's called the "Medicaid waiver" program to live in the community, but people with mental health problems don't have access to that.
Mental Health Screening ‘Not Perfect’
Since the mid-1970s, the population of the state's mental hospitals has fallen from 6,000 to fewer than 2,000. While the greatest percentage of the 17,800 discharges from state mental hospitals between January 2010 and the end of 2014 went to their own homes or those of relatives, about 1,800, or 10 percent, went to assisted-living facilities, adult-care homes or nursing homes, according to the Virginia Department of Behavioral Health and Developmental Services.
Latimer said long-term-care facilities are required to screen potential residents for mental health conditions and determine whether their needs can be met: "I think we recognize that is not a perfect process."
Sometimes a facility doesn't have all the information needed, and sometimes a hospital or case worker or family member is under pressure to find a place for someone who needs to leave a hospital because insurance won't continue to foot the bill. Long-term-care facilities also are under financial pressure to fill their beds.
A complicating factor in people with dementia is that their conditions change over time as the disease progresses.
Advocates for people with mental illness, dementia and brain injury tend to operate out of separate silos, even though their constituents often overlap in a loop that runs from emergency rooms to psychiatric units to long-term-care facilities.
"There's such incredible differences in the populations," Palmer said. "The reason they come together is, they are all incapacitated. They can't live independently."
Affordability Plays a Role
Latimer said economics play a role - those who have plenty of money are better able to find facilities with staffs specifically trained to deal with behavior problems; those who don't have a harder time.
The University of Pittsburgh study found an association between high resident-to-resident abuse rates and the following characteristics in assisted-living facilities: low staffing levels of nurses and certified nursing assistants; residents with dementia or physical limitations; and administrators with short tenure and low education.
"Most of these facilities are run by CNAs," Bennett said. "They are well-meaning people, but they're overworked and underpaid."
A Virginia Department of Health investigation four days after the beating found deficiencies, including not enough nurses to keep residents safe.
Nurse and CNA descriptions from that inspection show that since Brown's arrival in November 2012, he had bent back a nurse's finger, argued with his roommate, gone into other's people's rooms, grabbed another resident's arm and yelled at him, and urinated and defecated in other residents' rooms, sometimes in dresser drawers.
Lynne Jones Blain, a Richmond attorney representing Consulate Health Care of Windsor, declined to comment on the case, citing pending litigation.
A Peaceful Memory
Lorenz said she wants people to know one question she never thought to ask when she searched for a long-term-care facility for her grandmother: Is the staff trained to deal with aggression?
"You worry about neglect or someone stealing from them," she said, "but I never imagined someone crawling in her bed at night and beating her."
After her hospital stay, Williams moved to a nursing home in Portsmouth. Toward the end of her life a few months later, family gathered around her. Lorenz tried to replace the February 2013 memory with a peaceful one.
She lay quietly in bed next to her.
This article is adapted from a story written by Elizabeth Simpson for The Viginian-Pilot, through a Journalists in Aging Fellowship, a collaboration of New America Media and the Gerontological Society of America, with support from AARP. Part 2 will examine a more positive alternative.