ABC in Australia is reporting on an inquest that is ongoing in regard to violent attacks by a man in a high-care dementia ward which left one man dead and others in the ward seriously injured and terrified.

Charles McCulloch, 94, was found dead in his bed a day after he had moved into a high-care dementia ward at the Jindalee Aged Care Residence in Narrabundah in Canberra's south in 2012. When nursing staff came to check on him one Saturday morning in January, they found Mr McCulloch's face was covered in blood and it was suspected he had been bashed. Coroner Peter Dingwall heard nurses called the home's management to inform them of the incident.  Management told them to call a doctor first to figure out how he had died, before reporting the matter to police.  McCulloch's body was left unattended during the phone call and when the nurses returned they found a pillow over his face and paper napkins shoved down his throat. The court heard from police that during the commotion of Mr McCulloch's death another woman in the facility was also found bloodied and with a pillow over her face, but she survived. The court also heard a third resident told police that a man had attacked him that morning. "He kept punching me," the resident told police. "He grabbed my hair, and he grabbed my throat." The inquest heard another resident from the same ward, who had a history of lashing out at staff and patients, was suspected of bashing Mr McCulloch and the other two incidents. That allegedly violent man has since died. The inquest will not only investigate how the incident occurred, but whether the appropriate managerial policies and procedures were in place and followed at the time of the death.

ISSUES: Key Realisation:  incidents like this can and do happen in care homes where there are people who are living with dementia.  Are our services prepared? 1)  Repeated NEAR MISS events need to be quickly and effectively investigated and risk-assessed by management, especially where there is a risk to life, such as where a resident appears to be targeting violence towards the other very vulnerable people in the care environment. 2) Are the staff properly supervising the day-to-day events and interactions on the ward?  If so, then the pattern of events leading up to this kind of incident should have highlighted the potential risk and would have justified some interventions to properly safeguard the residents, including the man who was being violent. 3) One has to ask whether the staff are also properly prepared, briefed and trained to physically intervene if they came across the man in the violent act described above.  Many issues about duty of care, about use of force, about the kind of tactics that might be appropriate would need to be covered in a properly structured training programme, delivered by a qualified and experienced provider. 4) Why is the man who is suspected of carrying out these attacks becoming violent?  Aspects of care can and should be modified to suit the person's needs and to investigate the causes of violent or unpredictable behaviour...does he feel safe?  is there a hidden trigger here that we must uncover?  If we do not, then the results can be extremely tragic.

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My team and I have been providing challenging behaviour and physical interventions training to care homes for older people with dementia since 2006. With our https://www.dynamis.training/safe-caring/ and https://www.dynamis.training/safe-holding/ courses, we help organisations who look after older people who express distressed or combative behaviours. We help care services to:

• reduce injury risk and liability
• improve inspection compliance
• protect service's reputation from adverse incidents
• increase staff retention by supporting them with violence-related stress

My team and I help care homes for older people to deal with the elevated levels of risk which are now inherent in caring for the complex needs of people who are elderly, distressed, perhaps living with dementia or mental health problems.  We have been developing specialist experience with the issues involved in person-centred-care while managing aggression and distress. Here are our two most popular courses for teams who work with older people in care services. https://www.dynamis.training/safe-caring/ https://www.dynamis.training/safe-holding/