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James MacPherson, Associated Press, Published March 23 2009

North Dakota nursing home residents present unique challenges

BISMARCK – Before becoming “Resident 14” at a nursing home in northeast North Dakota, he was a laborer and loving family man – a gentleman by all accounts.

But the progression of Alzheimer’s disease in his 70s transformed him from a doting grandfather to a downright violent old man, wracking up some 50 assaults on patients and staff at the nursing home in New Rockford, where he lived for only a year before his death.

“He was a very nice man before he had Alzheimer’s,” said Ella Gutzke, administrator at the Lutheran Home of the Good Shepherd. “He was a big, strong man, and it was hard for him to adjust.

“He became one of our harder residents, definitely,” said Gutzke, who knew the man for years in the community before he came to the nursing home.

State officials say cases such as those of Resident 14 are not common among the approximately 5,700 nursing home residents in the state. But they illustrate the challenges facing caregivers.

Nursing homes typically segregate residents with Alzheimer’s and other forms of dementia.

At the nursing home in New Rockford, Resident 14 was in a separate part of the facility for Alzheimer’s patients, known as the Angel Wing, Gutzke said. The facility currently has 13 people in the Angel Wing and 67 in the main building, Gutzke said. The average age at the nursing home is 82, and none are younger than 70, she said. Some employees at the nursing home are in their 80s, she said.

That made Resident 14 – strong from years as a laborer – even more dangerous.

Investigation reports filed with the federal Department of Health and Human Services show he punched, kicked, scratched, spit and urinated on fellow residents and staff members.

Gutzke said one nurse had to take off work more than two months after the man injured her wrist.

To calm him, caregivers gave him a baby doll, thinking it would remind him of his grandchildren, Gutzke said. The doll repelled his demons for a time, until he started hitting people with it, she said.

The man had several incidents with one woman in her late 80s, who also had Alzheimer’s but could not walk and used a wheelchair.

“She was a pincher and a hurter and one of the most difficult residents besides him,” Gutzke said. “She was tough and didn’t like people getting into her space.”

Resident 14 was transferred several times to hospitals for psychiatric treatment but was always returned to the New Rockford facility. He died in 2007.

“We tried everything on this gentleman. Nothing worked. But you just can’t dump a resident,” Gutzke said.

“I think people need to know that we did everything we could,” she said. “All in all, he was no different than the next person, and we have to work with them as individuals.”

Bismarck attorney Gregory Larson said he’s one of about 10 lawyers in North Dakota specializing in elder law. He says resident-on-resident assaults are so rare in the state that he’s only had two cases in the past 15 years.

Larson credits caregivers at North Dakota nursing homes for quelling any potential problems.

“We’re a small-town state,” he said. “If you’re in a nursing home, it’s your neighbor taking care of you.”

Woody Gagnon, 94, a resident at a Bismarck nursing home, said he’s known many elderly people with Alzheimer’s disease or other mental illness. Most are harmless, he said.

“They’re relatively happy people; they don’t complain about anything, and they live one day to the other,” Gagnon said. “Sometimes, some of them can be violent, and when that happens you have to put them under constant control.”

Gagnon has been in a nursing home for about three years. He remembers at age 12 knowing an elderly man who would hit a church usher when the collection plate would be passed his way.

“In the old days,” Gagnon said, “we just called that old age.”

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