Long-term care facilities are, first and foremost, people's homes. And like most homes, they usually don't come with armed guards.
Security at the Carthage nursing home where eight people died following Sunday's shooting rampage was typical for long-term care facilities, experts say. The home was unlocked during the day and didn't have a security staff.
The state of North Carolina has numerous requirements meant to keep residents safe, including criminal background checks for employees, fire and disaster drills and mandatory reporting of abuse or neglect of residents. But the state doesn't require security guards, locked gates or doors, or other measures to control access. Those decisions are left to the individual facilities.
Several long-term care experts said Monday it would be difficult for any facility – a hospital, school or Wal-Mart – to protect against a gunman intent on violence.
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“If someone's heavily armed and is intent on killing innocent folks, then there's probably not going to be much you can do to stop them,” said Jeff Horton, acting director of the N.C. Division of Health Service Regulation.
In 1998, a man shot and killed his ex-girlfriend, a nursing assistant, in the parking lot of the Gaston County nursing home where she worked. Several residents sitting on the porch witnessed the murder, said Debi Lee, ombudsman for the Charlotte-based Centralina Area Agency on Aging.
Nursing homes, assisted-living centers and other long-term care facilities must balance resident safety and freedom, Lee said.
Being overprotective could add to residents' feelings of isolation, she said. “The real fear would be it would create a sense of incarceration.”
But Lee thinks long-term care facilities, or any workplace, should encourage staff members to reveal potentially dangerous personal situations. “If you have a restraining order against a boyfriend, you have to let people know that.”
Some continuing-care residential facilities, such as The Cypress in Charlotte, do require visitors to sign in with a guard at an entrance gate. The Cypress includes independent and assisted living as well as nursing care in a large development with controlled access.
But security at Charlotte's Golden Living Dartmouth nursing home is more typical of most long-term care facilities. During the day, visitors are asked to sign in with a receptionist. From 8 p.m. to 8 a.m., doors are locked, and visitors must ring a doorbell and check in with a staff member before entering.